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Interacting Water Insecurity and Food Insecurity: Recent Advances in Theory and Application

May 2025
American Journal of Human Biology 37(5):e70052

DOI:10.1002/ajhb.70052

Authors:

Alexandra Brewis

Arizona State University

Wendy Jepson

Texas A&M University

Asher Rosinger

Pennsylvania State University

Justin Stoler

University of Miami

Show all 7 authorsHide

Brewis, Workman et al. (2020) provided a basis for significant subsequent advancement in understanding the interplay between household water insecurity and food insecurity across diverse global contexts. This commentary reflects on the subsequent evolution of research and its application in the 5 years since the study's initial online publication in AJHB , highlighting dynamic mechanisms that link water insecurity and food insecurity and the implications for human health. Newer studies suggest that water insecurity may drive food insecurity more significantly than vice versa, with localized case studies revealing the diversity and complexity of multi‐scalar factors that contribute to these relationships. Future research priorities include more refined water insecurity measurement tools and further testing of potential mechanisms in theorized causal pathways linking water insecurity and food insecurity to each other and health outcomes.

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American Journal of Human Biology, 2025; 37:e70052

https://doi.org/10.1002/ajhb.70052

American Journal of Human Biology

SPECIAL ISSUE ARTICLE

Interacting Water Insecurity and Food Insecurity: Recent

Advances in Theory and Application

AmberWutich1 | SeraL.Young7

1School of Human Evolution and Social Change, A rizona State University, Tempe, Arizona, USA | 2Department of Geography, Texas A&M University,

College Station, Texas, USA | 3Department of Biobehav ioral Health, Pennsylvania State University, University Park, Pennsylvania, USA | 4Department

of Anthropology, Pennsylvania State University, University Park, Pennsylvania, USA | 5Department of Geography and Sustainable Development,

University of Miami, Coral Gables, Florida, USA | 6Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina,

USA | 7Department of Anthropology, Institute for Policy Research, Northwestern University, Evanston, Illinois,USA

Correspondence: Alexandra Brewis (alex.brewis@asu.edu)

Received: 19 December 202 4 | Revised: 16 April 2025 | Accepted: 17 April 2025

Funding: This work was supported by, National Science Foundation (SES - 1462086, SBE/BCS- 1759972), National Institute of Environmental Health

Sciences (R01ES 019841).

ABSTRACT

Brewis, Workman etal. (2020) provided a basis for significant subsequent advancement in understanding the interplay between

household water insecurity and food insecurity across diverse global contexts. This commentary reflects on the subsequent

evolution of research and its application in the 5 years since the study's initial online publication in AJHB, highlighting dynamic

mechanisms that link water insecurity and food insecurity and the implications for human health. Newerstudies suggest that

water insecurity may drive food insecurity more significantly than vice versa, with localized case studies revealing the diversity

and complexity of multi- scalar factors that contribute to these relationships. Future research priorities include more refined

water insecurity measurement tools and further testing of potential mechanisms in theorized causal pathways linking water

insecurity and food insecurity to each other and health outcomes.

1 | Introduction

The Brewis, Workman, etal.(2020) study that is the focus of our

commentary represented a multi- year effort by a large, global,

transdisciplinary team of researchers. Coordinated through the

Household Water Insec urity Experiences Re search Coordination

Network (HWISE- RCN, now the Water Insecurity Community

of Practice [WISE- CP]), this wider effort systematically docu-

mented, theorized, and addressed people's direct experiences

with water access and use. In this context, water insecurity

is defined as the ability to access and benefit from affordable,

adequate, reliable, and safe water for well- being and a healthy

life (Jepson etal.2017). While prior work stated that water and

food insecurity often co- occurred and demonstrated the rela-

tion in specific sites (e.g., Stevenson etal.2012), our paper was

significant as the first clear demonstration that household food

insecurity (much better studied) and water insecurity (previ-

ously little studied) co- existed within and across highly diverse

communities. We also identified multiple aspects of water inse-

curity (e.g., quality, quantity, labor required to fetch) positively

associated with worse food insecurity, with scarcity showing the

strongest correlation.

AJH B Invited Commentar y on: Brewis, A., Workman, C., Wutich, A., Jepson, and W., Young, S., Household Water Insecurity Experiences–Research Coordination

Network (H WISE- RCN). 2020. “Household Water Insecurity is Strongly A ssociated with Food Insecurity: Evidence From 27 Sites in Low- and Middle- Income

Countries.” American Journal of Human Biology, 32 no. 1: e23309. https:// doi. org/ 10. 1002/ ajhb. 23309 .

2 of 14 American Journal of Human Biology, 2025

But to us, as co- authors, the paper also reflected a significant

step in defining the wider emergent field of household water

insecurity since it was the first empirical study to emerge from

the then- nascent HWISE collaboration of 45 co- authors, sys-

tematically collecting comparative household- level data from

27 sites in 21 low- and middle- income countries. We followed

shortly thereafter with an important scale validation develop-

ment paper that produced the now- widely deployed HWISE

scale for measuring household- level water insecurity (Young

etal.2019). As of the end of 2024, more than 100 additional

studies have been published by the HWISE consortium (see

Appendi x A). Many deploy the comparative framework that

was launched with this paper, rapidly and significantly ex-

panding both measurement and theorization around house-

hold water insecurity.

In this commentary, we identify areas of water insecurity re-

search that follow fr om the Brewi s, Workman, etal.(2020) paper,

moving forward from demonstrating associations to building a

more comprehensive and sophisticated science of how water and

food insecurity are linked, with particular attention to the impli-

cations for human biology.

2 | Theorizing Mechanisms That Link Household

Food and Water Insecurity

In the Brewis, Workman, etal.(2020) paper, we suggested po-

tentially powerful mechanisms connecting household water,

food, and human biology. Parallel efforts to design more com-

prehensive models of water- food insecurity relationships that

can be tested against data are emerging (e.g., Miller, Workman,

etal.2021; Kisliuk etal.2024). Given cross- sectional data, in the

2020 paper we could not confirm directionality. But our diverse

field experiences anecdotally suggested (following Wutich and

Brewis2014) that household water insecurity likely drove food

insecurity rather than the converse. We noted that establishing

a consistent association between household food and water in-

security across diverse settings was an important first empirical

step in testing this core proposition. But to adequately test direc-

tional causation between household food, water, and biological

outcomes, longitudinal studies such as randomized- control tri-

als would also be required.

In the interim, several studies have confirmed our basic find-

ing of consistent and clear associations. Using nationally repre-

sentative samples from 25 low- and middle- income countries in

the cross- sectional Gallup World Poll data, Young etal.(2023)

reported the odds of being moderately- to severely food inse-

cure were two to three times as high when individuals were

moderately- to- severely water insecure, even when controlling

for many of the key predictors of food insecurity. Another re-

cent cross- sectional study from the Bolivian Amazon showed a

clear association between worse household water insecurity and

worse food insecurity in the contexts of a relatively water- rich

environment (Broyles etal.2024). While neither approach could

establish directionality, Broyles etal. made an important point

that factors above the household level might also be important

in explaining variation across sites, including precipitation,

temperature variability, market integration, and infrastructure

availability.

Related to this, further research has now demonstrated that this

relationship between water insecurity and food insecurity also

exists in high- income countries, while also suggesting that the

key mechanisms likely vary greatly across contexts. In analyses

of population- representative cross- sectional survey data from

the U.S., a proxy of water insecurity (i.e., tap water avoidance)

was found to be strongly associated with greater odds of food in-

security among both adults (Rosinger, Bethancourt, etal.2023)

and children and adolescents (Rosinger and Young2024). This

relationship held even after adjusting for other measures of

vulnerability (e.g., low income or housing) that structure food

insecurity. The authors proposed, but could not confirm, that

tap water distrust leads to increased spending on bottled water

as well as other beverages, which takes money away from food

budgets, thereby increasing food insecurity.

Work confirming theorized directionality is now beginning.

Miller etal.(2024) used panel data from smallholder agricultur-

alists in four countries in sub- Saharan Africa. They found that

reports of water insecurity at time 1 were associated with lower

dietary diversity at time 2, but not with greater food insecurity.

They suggested this may be because water insecurity lowered

the consumption of starches (and possibly other foods) over

time. Directionality and—ideally—causality need to be more

clearly established. Associated efforts to build models with com-

munity members provide an inductive means to identify even

more variables that could be included and different ways they

should be organized to suggest testable relationships between

causes and consequences (e.g., Ahmed etal.2021).

While randomized experimental and similar designs are the

gold standard, they can be difficult to deploy in the types of field

studies conducted by human biologists. Working with agencies

to test interventions may show how different pathways from

water insecurity to food insecurity may alleviate either or both

would be a productive way to continue building theory while

also supporting practical applications. At the same time, by fo-

cusing on better understanding mechanisms in the contexts of

likely diverse and intersecting causal pathways, interventions

can also be better designed to alleviate both water insecurity

and food insecurity. Future work should also focus on how ul-

timate factors, like extreme climatic events or policies, change

water access while simultaneously also affecting diets.

3 | Recognizing Water- Food Insecurity as

Complexly Dynamic

One related challenge is how to deal with inherent dynamic vari-

ation within our sites that may or may not relate to causation.

Our study captured and compared food- water associations in

households in a wide array of water- insecure conditions with a

4- week recall and did not include a role for seasonality, water

intermittency, climate shocks, or related community adaptation

and recovery (such as shifting water allocation strategies).

3.1 | Water Intermittency

Intermittent water supplies—those that do not run continu-

ously 24 h per day—are used by over 1 billion people globally

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with broad implications for water quality and diarrheal diseases

(Bivins etal.2017; Kumpel and Nelson2016). Social factors that

affect water availability, reliability, and affordability can vary

daily and artificially induce intermittent access, independent

of water system operations (Price etal.2019). With appropriate

household infrastructure (e.g., water tanks, electric pumps, and

effective household water treatment) intermittency can be ren-

dered invisible. But for much of the world, intermittent water

access—particularly when unpredictable—is known to be asso-

ciated with heightened water insecurity (Jepson etal.2021) and

psychosocial stress (Thomson, Pearson, et al. 2024) because it

limits people's ability to adapt their daily schedules.

These same dynamics likely exacerbate food insecurity for

hundreds of millions of people globally through two primary

mechanisms and provide another area for theorization and

testing of key mechanisms. For example, due to the impor-

tance of water in non- preprocessed food preparation (e.g.,

washing and boiling), intermittent water access may compel

shifts in what foods can be prepared on a given day—includ-

ing the use of more preprocessed and less nutritious foods.

Another possibility is that intermittency may drive up water

costs as residents adapt to changing needs and backup water

sources (Beard and Mitlin 2021), leading to tradeoffs in the

remaining disposable income available for food purchases

and hence worsening food insecurity. Because supplies are

often controlled within urban piped water systems to ration

household water use, intermittency may ultimately be viewed

as a structural factor that jointly perpetuates water and then

food insecurity. How intermittent water access—regardless of

urbanicity—can be managed to mitigate negative effects on

nutrition and health (and poverty more broadly) is thus an in-

teresting line for future enquiry.

3.2 | Seasonality, Extreme Climate Events,

and Climate Change

Water insecurity is influenced by local hydrological and sea-

sonal dimensions and thus is sensitive to both regular and ir-

regular variation in precipitation (Broyles etal.2022). When we

developed our initial AJHB paper, we did not have a meta- data

or sample structure to manage seasonality as a dynamic variable

in the analysis, so we simply listed the data collection season

(Brewis, Workman, etal.2020; Brewis, see Piperata, etal.2020,

tab. 1 for context). But we assumed that water insecurity and

food insecurity dynamics shift with seasonal climatic changes

to increase and decrease nutritional and other health risks

through time and that communities would also have adaptive

strategies to manage this in some fashion.

Beyond normal seasonal fluctuations, some of the sites in our

analysis were in greater climatic or disaster- induced water cri-

sis than others—a factor we also could not consider at that

time. Extreme climatic events are becoming more frequent

and more severe (Pörtner etal. 2022). Studies are now exam-

ining how extreme climatic events, such as flooding, drought,

or hurricanes/cyclones, function as shocks and affect either

water insecurity (Roque etal. 2021) or food insecurity alone

(Prall and Scelza2023). But the next step is to connect water

and food insecurity in the context of extreme events that

disrupt multiple dimensions of water insecurity, such as ac-

cess, quality, and reliability (Jankovic- Rankovic et al. 2024)

with likely severe implications for dimensions of food insecu-

rity (Hanjra and Qureshi2010). For example, drought reduces

water access and availability for all uses, including hygiene,

drinking, and food via water for agriculture, livestock, and

cooking, thus compounding both water insecurity and food

insecurity. During a 2020–23 historic drought in the Greater

Horn of Africa in which hundreds of thousands of livestock

died, Daasanach semi- nomadic pastoralists in northern

Kenya indicated that both water insecurity and food insecu-

rity worsened, and this stress was confirmed in greater fin-

gernail cortisol concentration (Rosinger etal.2024). Notably,

water problems were cited by the pastoralists as a main reason

for planned out- migration.

Temporal dynamics may be very important here; while both

water insecurity and food insecurity are sensitive to climate

change and extreme climatic events, the recovery from these

events does not proceed at the same rate. For example, recent

findings from lowland Bolivia demonstrate that even as water

insecurity improved over 2 months after severe f looding,

Tsimane’ adult food insecurity did not improve, and in fact se-

vere food insecurity worsened (Rosinger, Rosinger, etal.2023).

This was because of the flood's (i.e., excess water) destructive ef-

fects on crops and game. Similarly, when severe drought among

pastoralists causes livestock death, critical sources of nutrition

(e.g., milk and meat) disappear leading to malnutrition (Bauer

and Mburu2 017). Therefore, when extreme water events funda-

mentally destroy food supply, recovery is much longer and the

implications on human biology and nutritional status are com-

pounded. This, and other ways that climate change and extreme

climatic events affect water insecurity and food insecurity inter-

action and their health consequences,are open areas for further

research (Rosinger2023).

3.3 | Intra- Household Dynamics

Prior work by human biologists has shown how households may

allocate scarce nutritional resources in line with biocultural

buffering theories. Specifically, mothers may buffer others (most

often children—especially boys, and sometimes men) by allo-

cating more or better- quality food to them, perhaps with sub-

sequent energetic or even possible epigenetic effects (Piperata

etal.2013). Such buffering has been observed under an array of

food insecure conditions (e.g., Panter- Brick1993; Leonard1991;

Piperata etal. 2013; Hadley etal. 2008). But notably, the prox-

imate strategies and rationale vary from ensuring youth can

labor (Peru and Ethiopia) or badgering by children (Amazon).

Our 2020 finding that water and food insecurity consistently

co- occur buttressed the theoretical possibility that households

could be buffering members through purposeful allocation

strategies in water, as has been observed for food, even possibly

in trade- offs with each other. But our 2020 analysis was limited

to household- level data, so we could not advance this proposi-

tion any further, even though we suspected it to be an important

area for further theory building.

Published subsequently, Maxfield's (2020) study within urban

households in Jaipur, India tested for perceived discordance of

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household members' responses on food and water insecurity

scales. This importantly and consequentially moved below the

household level to assess water insecurity as an individual- level

experience identifying adult buffering of adolescents in both

food and water, especially of boys. Other scholars are deploying

ethnographically detailed case studies to develop and expand

theories specific to intra- household water buffering strategies,

suggesting they may even favor women—in direct contrast to

what has been generally observed for food buffering (Hossain

et al., forthcoming). The next step will be creating similarly

detailed case studies that capture multiple dimensions of trade-

offs in both food and water, including how they relate to each

other. This will advance wider theories of biocultural buffering

that center interactions between crucial scarce resources rather

than viewing them independently.

One significant known challenge is that food insecurity re-

ports (such as by mothers) on other household members (such

as children) can prove inaccurate, meaning more complex and

expensive research designs are required that can capture data

directly from multiple individual household members (e.g.,

Bernal etal.2016; Frongillo etal.2019). We expect this chal-

lenge to be relevant to estimating intra- household water allo-

cations. For example, Nébié etal. (2024, tab. 4) have shown

that male and female spouses in the same Burkina Faso

households do not necessarily report household water secu-

rity similarly, and the pattern of difference between spouses

tracks with gender but also shifts across different subsistent

livelihoods.

3.4 | Syndemic Interactions

As newer studies increasingly connect food and water insecurity

and consider their dynamic, the application of biocultural theory

is helping to consider how this then affects health and other bi-

ological outcomes. Workman etal.(2022) called for a syndemic

approach to understanding water insecurity, food insecurity, and

human health, studying clusters of illness as inter- related, with

significant implications for interventions that center on social

and structural factors. Syndemic analyses emphasize complex

feedback relationships between pathogens and/or disease states

and thus attempt to model human health outcomes accordingly

(e.g., Singer etal.2017; Tsai 2018).

Recent research on food- water- distress has explicitly adopted

a syndemic approach (Kimutai etal. 2023), applied in a range

of studies including intersections with COVID- 19 in 23 low-

and middle- income countries (Stoler etal.2021) and Indonesia

(Charles etal. 2023), dam- displaced women in Kenya (Owuor

et al. 2023), dual- disease burdens in Ecuador (Thompson

etal.2022), gender and climate concerns in rural sub- Saharan

Africa (Apatinga et al. 2022), and women living with HIV in

Kenya (Boateng etal.2022).

Reflecting on methodological critiques of existing syndemic

research that identified co- occurring diseases and stressors

(Mendenhall etal.2022; Tsai etal.2017, Tsai 2018), recent stud-

ies have focused on demonstrating statistically and clinically

significant interactions between them. Boateng et al. (2022)

found that water insecurity in Kenya was associated with and

predicted food insecurity at later time points, with significant

interaction effects reported from the models. In nationally rep-

resentative data from Mexico, Bose et al.(2025) demonstrated

that joint food and water insecurity increased the likelihood of

probable depression, and that these relationships did not differ

between men and women. Charles et al.(2023) found a stron-

ger association between joint—as opposed to solo—food and

water insecurities on depression scores in Indonesia. In Ghana,

Kangmennaang and Elliott(2024) found that households with

medium water insecurity and severe food insecurity had a

higher likelihood of reporting emotional distress. In line with

syndemic frameworks, they also found that food and water in-

security of varying degrees of severity significantly interacted

and that other stressors such as housing insecurity and income

inadequacy also affected well- being.

The syndemic relationship between food and water insecurities

is evidenced in physical health outcomes as well. In Ecuador,

household food insecurity was associated with increased diar-

rhea in children, and water insecurity was associated with respi-

ratory infections in children, but their interaction elevated was

associated with a greater risk of both diarrhea and respiratory in-

fections (Chakraborty etal.2024). The predictive relationship be-

tween household water insecurity and household food insecurity

holds true even in water- rich environments (Broyles etal.2024).

Future work may extend syndemic studies of the water- food-

health nexus to include household energy (Boateng2021) and

sanitation (Workman etal.2022) insecurity.

4 | Establishing Biological Consequences of

Water- Food Insecurity

As food and water insecurity are now recognized to co- occur

and dynamically interact, the implication for human biological

research is that both should be measured when explicitly con-

sidering their potential roles in health and nutrition outcomes.

4.1 | Health and Nutrition

Compounded effects of water- food insecurity are now being

established, given the agenda of measuring food and water

insecurity simultaneously. Associations are being observed

in many different domains. One of the earlier papers from

the HWISE scale development study showed strong relation-

ships between experiences with water insecurity and reported

difficulties with breastmilk and non- breast infant feeding

(Schuster etal. 2020). For another example, joint water and

food insecurity was significantly associated with higher odds

of dehydration among forager- horticulturalists in lowland

Bolivia (Bethancourt et al. 2021). In a study with highland

Tanzanian youth and adolescents, the odds of experiencing in-

timate partner violence were higher for females experiencing

water insecurity, and associations were significant (if weaker)

when controlling for food insecurity (Kisliuk etal.2024). In a

study among Kenyan adults living with HIV, food insecurity

and water insecurity were associated with numerous physical

health outcomes; accounting for both resource insecurities

typically provided the best model fit (Nagata etal.2022; Miller,

Frongillo, etal.2021).

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4.2 | Sanitation

While much of the emphasis linking water insecurity and nu-

tritional outcomes has focused predominantly on agriculture

and food production, there are multiple pathways through

which water insecurity impacts household and individual nu-

trition (Choudhary et al. 2020). In a study using nationally

representative data from 18 countries, Choudhary etal.(2024)

found water insecurity was associated with stunting (i.e., low

height- for- age) and anemia (i.e., hemoglobin levels) and was

mediated through dietary diversity. This study controlled for

household sanitation and suggested the need to understand

water insecurity and sanitation insecurity (lack of access to

adequate and safe sanitation facilities) as separate, but re-

lated, constructs. They further suggest that child health and

nutritional outcomes are influenced by both direct and in-

direct pathways. While the studies have suggested different

proportional inf luences of water and sanitation insecurities,

they nonetheless indicate the need for attention on a plurality

of environmental exposures and pathways that link resource

insecurities with health outcomes for both children and adults

(Rhue etal.2023; Workman etal.2022).

Many existing studies link WaSH (Water, Sanitation and Hygiene)

insecurity or insufficiency with nutritional outcomes in chil-

dren. For example, diarrhea and undernutrition attributable to

WaSH are 69% and 10%, respectively (Wolf etal.2023). Diarrhea

resulting from the ingestion of infectious agents can occur

through drinking (Goddard et al. 2020) as well as insufficient

hand hygiene among children (Goddard etal. 2020) and care-

givers (Aydamo etal. 2024). Given the importance of multiple

environmental exposures, studies suggest that fecal exposures re-

sulting from insufficient sanitation are central to understanding

child health outcomes (Goddard etal.2020). In Cameroon, evi-

dence suggests a dose–response relationship between distance to

household water sources and level of household food insecurity

(Nounkeu etal.2022). In the same study, food insecure house-

holds that practiced open defecation had higher odds of report-

ing diarrhea in children, and improved handwashing buffered

against diarrheal incidence. In support of attention to sanitation

in addition to water and food insecurity, a study in Indonesia

found that improved sanitation and not water had protective

effects for stunting (Rah et al. 2020). Greater theorization and

clarification of potential causal mechanisms is needed in terms

of a defining the roles of sanitation insecurity alongside and in-

teracting with food insecurity and water insecurity in shaping

health and human biological outcomes.

4.3 | Stress and Mental Health

By 2019, there was a nascent field of scholarship suggesting a

relationship between water insecurity and emotional distress,

psychosocial well- being, and mental ill- health (Wutich and

Ragsdale2008; Sultana 2011; Stevenson etal.2012). Our 2020

findings from 27 sites in low- and middle- income countries ex-

plored food- related anxieties in water- insecure households and

outlined pathways that might explain these emergent findings,

including lowered food consumption, limited food choices,

and food safety issues. We suggested water anxieties might

manifest differently in rural and urban households, with rural

households being more insulated from food quantity impacts,

while urban households were more shielded from food qual-

ity ones. Concurrent research from urban and rural sites in

Haiti found that water insecurity was directly associated with

increased anxiety and depression symptoms in both contexts,

and food insecurity similarly mediated the relationship between

water insecurity and anxiety/depression (Brewis etal.2019).

Recent reviews and studies reaffirm the importance of disen-

tangling the complex relationship between water insecurity,

food insecurity, and mental ill- health (Wutich et al. 2020;

Wutich 2020; Nounkeu and Dharod 2020; Miller, Frongillo,

et al. 2021; Kimutai et al. 2023; Bennett et al. 2023; O'Brien

etal.2024). Qualitative and mixed- method studies have added

ethnographic nuances to better understand possible pathways

that might explain how food insecurity mediates the relation-

ship between water insecurity and mental ill- health. Examples

include concerns of spousal violence from serving less- palatable

meals made with too little or low- quality water in Uganda

(Mushavi et al. 2020), distress of changed cooking plans in

Cameroon (Nounkeu et al. 2022), and complex issues around

lactation and infant feeding in Pakistan (Ahmed etal.2021).

Bethancourt etal.(2023) highlight the high cross- site variability

in the mechanics of water- food- distress interactions and call for

more research to discern how contextual factors such as climate

and seasonality, subsistence patterns, and water infrastructures

might shape these interactions. Additional future work may

benefit from focusing on the household as the center of food-

water interactions and as a core site for creating or buffering

distress responses, as noted in Brewis, Workman, etal.(2020).

Maxfield's(2020) study in Jaipur, India of gender and age biases

in household buffering from water and food insecurity—and its

implications for anxiety/depression symptoms—is another good

model of this approach. Another fruitful direction for future re-

search is on the complexities of spatial heterogeneity in shaping

water- food- distress interactions (Stuart etal.2023), which may

help explain why the success of water interventions is not yet

predictable. One important study has connected responsibility

for household water in Nepal) to heightened blood pressure, even

as food insecurity also had an effect (Brewis etal.2019), suggest-

ing water's stress effects may be seen physiologically and interact

with food insecurity. This is an area in which human biologists

are especially well placed to advance.

5 | Refining Water Insecurity Measurement

Advancing the science outlined above, such as dynamically

connecting food and water insecurity to each other and health/

nutrition outcomes, requires tools that capture meaningfully

the relevant aspects or dimensions of water insecurity across

diverse environments. In the 2020 paper, we explored whether

the selected scale items were adequately capturing the relevant

aspects of water insecurity to understand how and why it relates

to household food and other domains.

We raised the concern—one that remains—that perceived and

chemically assessed water quality also mattered to food secu-

rity and nutrition but was not directly captured in the HWISE

scale items. We know that expected nutritional benefits of more

6 of 14 American Journal of Human Biology, 2025

access to water may be unrealized because of the persistent

challenge of water quality (Usman and Gerber2020). Without

inclusion of water quality in the next generation of metrics,

we lack insight into how perception of poor water quality in-

fluences food and nutritional behaviors in the household. For

example, as noted above, tap water avoidance, which one may

hypothesize as related to perception of water quality, is related

to food insecurity; but without clear inclusion of water quality

in a household metric, researchers will have difficulty testing

these theories. Additionally, as the international community

looks to diversify water security by improving water source ac-

cess through unconventional systems (e.g., multiple- use water

systems), the persistent challenge of water quality may still

undermine possible co- benefits (Jepson etal.2023). Thus, fu-

ture research needs to account for water quality as behavioral

responses to these concerns cascade into a range of household

decisions that directly (e.g., food preparation and food choice)

and indirectly (e.g., cost of managing water quality that limit

household resources for food) impact nutrition. Therefore, the

next generation of metrics will require careful attention to how

water quality (e.g., organoleptic and perception of harm) is

better assessed to allow for more refined analysis of the food/

nutrition- water security nexus.

We have since (Stoler etal. 2023) clarified additional relevant

aspects of water insecurity measurement that are highly rele-

vant but are absent in the current scale, especially severity,

adaptation, and resilience (e.g., the ability of households to

none- the- less produce sufficient safe and nutritious food even

when faced with high levels of water insecurity). Yet, for those

living in urban areas where food resources are available only

through the market, water affordability, which refers to the costs

required to obtain a necessary level of drinking water service or

quantity (Pierce etal.2021; Goddard etal.2021), directly influ-

ences capacity to purchase needed food resources. Despite its

importance, measuring water affordability remains a challenge

(Goddard etal.2022; Nemati and Schwabe2023). Therefore, the

next generation of water insecurity metrics needs to incorporate

affordability meaningfully into the equation.

The ongoing development and validation of individual- level

Water Insecurity Experiences (IWISE) scales (Bethancourt

etal.2022; Young etal.2021) also permits more detailed intra-

household study of variations in water insecurity (Wutich and

Brewis 2014), including how water insecurity varies by gender

(Young etal. 2022). These are especially relevant to human bi-

ology given the need for individual assessments that can be

associated with (necessarily individualized) biomarker, anthro-

pometric, and other human biological data—better understand-

ing implications for health and nutritional status. This can then

allow, for example, more systematic and detailed intra- household,

within- site, and cross- site comparisons) to reveal much about

how household food and water management strategies interact

to shape differential health and nutrition outcomes.

Additional and more sophisticated approaches to modeling food

insecurity and water insecurity will also allow us to advance the-

ory but also our core water insecurity measurements. Koyratty

et al. (2021), for example, used multiple correspondence anal-

ysis to develop new measures of both food and water insecu-

rity. Similarly, measures of emotional distress, psychosocial

well- being, or mental ill health can be used to validate new water

insecurity and food insecurity measures (Jepson etal.2021).

6 | Ensuring Applicability to Policy and Practice

Food security has long been a major investment space in pub-

lic health and international development. One purpose behind

our wider agenda to understand food- water insecurity dynam-

ics has been establishing evidence that investments in improv-

ing water security (e.g., MAD water systems (Thomson, Stoler,

etal.2024; Wutich etal.2023)) can strengthen efforts to improve

nutrition. It is thus gratifying to observe that it is increasingly

common for food researchers to control for water insecurity,

even in primarily nutritional studies (e.g., Jayaweera etal.2022;

Martinez- Brockman etal.2023). Simultaneous measurement of

experiences of water and food insecurity has also proved pow-

erful at activating public and political will. For example, a pol-

icy brief—based on sur veys initiated by the Dharriwaa Elders

Group and the Walgett Aboriginal Medical Service—linked

experiences of food and water insecurity in their community

(Tonkin et al. 2023). This report caught the attention of the

Australian press and triggered a coordinated government re-

sponse. This case then highlighted the utility of the HWISE and

IWISE Scales as policy tools (Nature2023).

The uptake for understanding the role of experiences with water

insecurity for public health policy is also clear in the inclusion

of HWISE and IWISE Scales in large governmental and non-

governmental surveys. For example, Mexico's National Institute

of Public Health has incorporated HWISE in their annual na-

tional health and nutrition surveys since 2021 (Shamah- Levy

etal. 2023). Similar efforts to measure water insecurity within

large public health surveys are ongoing elsewhere in Latin

America (PENSSAN Research Network2022). Because of their

relevance for deciding where interventions are most needed and

evaluating the impact of interventions, the World Bank has de-

ployed HWISE scales to understand the impact of multi- million-

dollar infrastructural interventions (Shekar et al. 2024). The

Water Insecurity Experiences- Latin America Caribbean (WISE-

LAC) network wrote in their position statement that concurrent

measurement of experiential food and water insecurity has “the

potential to inform the development of better- targeted interven-

tions that can advance human and planetary health” (Melgar-

Quiñonez etal.2023, 1). This is being tested in settings as diverse

as Nepal, Madagascar, and India (Young etal.2024). We expect

this to be an energetic space in which human biology can con-

tribute meaningfully to policy in the years ahead.

7 | Concluding Remarks

In our original paper we outlined some next steps to advance

and apply knowledge on how food insecurity and water inse-

curity interact to shape human biological variation. In just a

few short years since, the field has advanced notably on each

suggestion, including better measures of water insecurity, incor-

porating the dynamic contexts of household water insecurity,

testing how extreme climatic events affect both water and food

insecurity, developing detailed case studies to better theorize

underlying mechanisms, moving toward studies that can better

7 of 14

test directionality or even causality, and explicitly connecting

findings to policy. Yet, as we have outlined here, there is still

much to be done and many frontiers to explore. We are still in

the very early days of establishing clear directionality, clarifying

underlying mechanisms, and identifying how these vary across

diverse climatic and economic contexts. Robust research in all

these areas has the potential to assist with the profound global

challenge of billions living with water insecurity in the uncer-

tain decades ahead.

Acknowledgments

The original study was funded by Competitive Research Grants to Develop

Innovative Methods and Metrics for Agriculture and Nutrition Actions

(IMMANA); National Institute of Environmental Health Sciences,

Grant/Award Number: R01ES019841; National Science Foundation,

Grant/Award Number: SES- 1462086. Subsequent research described

herein by HWISE- RCN was funded by NSF BCS/SES- 1759972. Our orig-

inal co- authorship team included the following as collaborating HWISE-

RCN members: Ellis Adams, Jam Farooq Ahmed, Mallika Alexander,

Mobolanle Balogun, Michael Boivin, Genny Carrillo, Kelly Chapman,

Stroma Cole, Shalean Collins, Luisa Figueroa, Matthew Freeman, Asiki

Gershim, Hala Ghattas, Ashley Hagaman, Zeina Jamaluddine, Desire

Tshala- Katumbay, Divya Krishnakumar, Kenneth Maes, Jyoti Mathad,

Jonathan Maupin, Patrick Mbullo, Joshua Miller, Ica Martin Muslin,

Monet Niesluchowski, Nasrin Omidvar, Amber Pearson, Hugo Melgar-

Quiñonez, Cuauhtemoc Sanchez- Rodríguez, Marianne Vicky Santoso,

Roseanne Schuster, Sonali Srivastava, Chad Staddon, Andrea Sullivan,

Yihenew Tesfaye, Nathaly Triviño, Alex Trowell, Raymond Tutu, Jorge

Escobar- Vargar, and Hassan Zinab.

Ethics Statement

The authors have nothing to report.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated

or analysed during the current study.

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Rosinger, A. Y., J. Stoler, L. B. Ford, et al. 2024. “Mobility Ideation due

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Rosinger, A. Y., and S. L. Young. 2024. “Trends and Disparities in

Concurrent Tap Water Avoidance and Household Food Insecurity

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Network (HWISE- RCN). 2020. “If There Is no Water, We Cannot Feed

Our Children: The Far- Reaching Consequences of Water Insecurity on

Infant Feeding Practices and In fant Health Across 16 Low- and Middle-

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e23357. https:// doi. org/ 10. 1002/ ajhb. 23357 .

Shamah- Levy, T., V. Mundo- Rosas, A. Muñoz- Espinosa, et al. 2023.

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en Hogares Mexicanos.” Salud Pública de México 65, no. 3: 219–226.

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Shekar, M., K. S. Okamura, M. Vilar- Compte, and C. Dell'Aira. 2024.

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world bank. org/ en/ topic/ nutri tion/ publi ca tion/ inves tment - f rame work-

nutri tion.

Singer, M., N. Bulled, B. Ostrach, and E. Mendenhall. 2017. “Syndemics

and the Biosocial Conception of Health.” Lancet 389, no. 10072: 941–

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Stevenson, E . G., L. E. Greene, K. C. Maes, etal. 2012 . “Water Insecurity

in 3 Dimensions: An Anthropological Perspective on Water and

Women's Psychosocial Distress in Ethiopia.” Social Science & Medicine

75, no. 2: 392–400. https:// doi. org/ 10. 1016/j. socsc imed. 2012. 03. 022.

Stoler, J., W. E. Jepson, A. Brewis, and A. Wutich. 2023. “Frontiers

of Household Water Insecurity Metrics: Severity, Adaptation and

Resilience.” BMJ Global Health 8, no. 5: e011756. https:// doi. org/ 10.

1136/ bmjgh - 2023- 011756.

Stoler, J., J. D. Miller, A. Brew is, etal. 20 21. “Household Water Inse curity

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Sites in 23 Low- and Middle- Income Countries.” International Journal

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1016/j. ijheh. 2021. 113715.

Stuart, E., J. Stoler, A. L. Pearson, and G. Asiki. 2023. “Spatial

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Sultana , F. 2 011. “Suffering for Water, Suf fering From Water: Emotional

Geographies of Resource Access, Control and Conflict.” Geoforum 42,

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Usman, M. A ., and N. Gerber. 2020. “I rrigation, Dri nking Water Quality,

and Child Nutritional Status in Northern Ethiopia.” Journal of Water

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org/ 10. 2166/ washd ev. 2020. 0 45.

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Workman, C. L., J. Stoler, A. Harris, A. Ercumen, J. Kearns, and K. M.

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Wutich, A. 2020. “Water Insecurity: An Agenda for Research and Call

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Wutich, A., and A. Brewis. 2014. “Food, Water, and Scarcity: Toward a

Broader Anthropology of Resource Insecurity.” Current Anthropology

55, no. 4: 444–468. https:// doi. org/ 10. 1086/ 677311.

Wutich, A., A. Brewis, and A. Tsai. 2020. “Water and Mental Health.”

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1002/ wat2. 1461.

Wutich, A., and K. Ragsdale. 2008. “Water Insecurity and Emotional

Distress: Coping With Supply, Access, and Seasonal Variability of Water

in a Bolivian Squatter Settlement.” Social Science & Medicine 67, no. 12:

2116–2125. https:// doi. org/ 10. 1016/j. socsc imed. 2008. 09. 042.

Wutich, A., P. Thomson, W. Jepson, etal. 2023. “M AD Water: Integrati ng

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in the Climate Change Era.” Wiley Interdisciplinary Reviews: Water 10,

no. 6: e1680. https:// doi. org/ 10. 1002/ wat2 . 1680.

Young, S. L., H. J. Bethancourt, E. A. Frongillo, S. Viviani, and C.

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Low- and Middle- Income Countries.” Bulletin of the World Health

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Young, S. L., H. J. Bethancourt, Z. R. R itter, and E. A. Frongillo.

2021. “The Individual Water Insecurity Experiences (I WISE) Scale:

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Water Security.” BMJ Global Health 6, no. 10: e006460. https:// doi. org/

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Young, S. L., H. J. Bethancourt, Z. R. R itter, and E. A. Frongillo. 2022.

“Estimating National, Demographic, and Socioeconomic Disparities

in Water Insecurity Experiences in Low- Income and Middle- Income

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11 of 14

Appendix A

HWISE- RCN Publications Through 2024

Adams, E . A., J. Stoler, and Y. Adams. 2020. “Water Insecurity and

Urban Poverty in the Global South: Implications for Health and Human

Biology.” American Journal of Human Biology 32, no. 1: e23368. ht tps ://

doi. org/ 10. 1002/ ajhb. 23368 .

Akhter, M., S. M. N. Uddin, N. Rafa, S. M. Hridi, C. Staddon, and W.

Powell. 2020. “Drinking Water Security Challenges in Rohingya

Refugee Camps of Cox's Bazar, Bangladesh.” Sustainability 12, no. 18:

7325. https:// doi. org/ 10. 3390/ su121 87325 .

Beresford, M. 2020. “ The Embedded Economics of Water: Insights

From Economic Anthropology.” Wiley Interdisciplinary Reviews: Water

7, no. 4: e1443. https:// doi. org/ 10. 1002/ wat2. 1443.

Beresford, M., A. Brewis, N. Choudhary, etal. 202 4. “Justice and Moral

Economies in “Modular, Adaptive, and Decentralized”(MAD) Water

Sy stems.” Water Security 21, no. 100: 148. https:// doi. org/ 10. 1016/j.

wasec. 2023. 100148.

Beresford, M., A. Wutich, D. Garrick, and G. Drew. 2023. “Moral

Economies for Water: A Framework for Analyzing Norms of Justice,

Economic Behavior, and Social Enforcement in the Contexts of Water

Inequality.” Wiley Interdisciplinar y Reviews: Water 10, no. 2: e1627.

https:// doi. org/ 10. 1002/ wat2. 1627.

Bethancourt, H. J., Z. S. Swanson, R. Nzunza, etal. 2021. “Hydration in

Relation to Water Insecurity, Heat Index, and Lactation Status in Two

Small- Scale Populations in Hot- Humid and Hot- Arid Environments.”

American Journal of Human Biology 33, no. 1: e23447. https:// doi. org/

10. 1002/ ajhb. 234 47 .

Boateng, G. O., C. L. Workman, J. D. Miller, M. Onono, T. B. Neilands,

and S. L. Young. 2022. “The Syndemic Effect s of Food Insecurity, Water

Insecurity, and HIV on Depressive Symptomatology Among Kenyan

Women.” Social Science & Medicine 295, no. 113: 043. https:// doi. org/ 10.

1016/j. socsc imed. 2020. 113043.

Brewis, A., N. Choudhary, and A. Wutich. 2019. “Household Water

Insecurity May Influence Common Mental Disorders Directly and

Indirectly Through Multiple Pathways: Evidence From Haiti.” Social

Science & Medicine 238, no. 112: 520. https:// doi. org/ 10. 1016/j. socsc

imed. 2019. 112520.

Brewis, A., L. Z. DuBois, A. Wutich, et al. 2024. “Gender Identities,

Water Insecurity, and Risk: Re- Theorizing the Connections for a

Gender- Inclusive Toolkit for Water Insecurity Research.” Wiley

Interdisciplinary Reviews: Water 11, no. 2: e1685. https:// doi. org/ 10.

1002/ wat2. 1685.

Brewis, A., K. T. Roba, A. Wutich, M. Manning, and J. Yousuf. 2021.

“Household Water Insecurity and Psychological Distress in Eastern

Ethiopia: Unfairness and Water Sharing as Undertheorized Factors.”

SSM- Mental Health 1, no. 100: 008. https:// doi. org/ 10. 1016/j. ssmmh.

2021. 100008.

Brewis, A., A. Rosinger, A. Wutich, et al. 2019. “Water Sharing,

Reciprocity, and Need: A Comparative Study of Interhousehold Water

Transfers in Sub- Saharan Africa.” Economic Anthropolog y 6, no. 2:

208 –221. https:// doi. org/ 10. 1002/ sea2. 12143 .

Brewis, A., C. Workman, A. Wutich, et al. 2020. “Household Water

Insecurity Is Strongly Associated With Food Insecurity: Evidence From

27 Sites in Low- and Middle- Income Countries.” American Journal of

Human Biology 32, no. 1: e23309. https:// doi. org/ 10. 1002/ ajhb. 23309 .

Brewis, A., A. Wutich, M. Galvin, and J. Lachaud. 2022. “Localizing

Syndemics: A Comparative Study of Hunger, Stigma, Suffering, and Crime

Exposure in Three Haitian Communities.” Social Science & Medicine 295,

no. 113: 031. https:// doi. org/ 10. 1016/j. socsc imed. 2020. 113031.

Brewis, A. A., B. Piperata, A. L. Thompson, and A. Wutich. 2020.

“Localizing Resource Insecurities: A Biocultural Perspective on Water

and Wellbeing.” Wiley Interdisciplinary Reviews: Water 7, no. 4: e1440.

https:// doi. org/ 10. 1002/ wat2. 1440.

Choudhary, N., A. Brewis, M. Beresford, C. Workman, and A. Wutich.

2022. “Water, Economic Systems, and Mental Health: A Review of

Theorized Relationships.” CABI Reviews 2022. https:// doi. org/ 10. 1079/

cabir eview s2022 17042 .

Choudhary, N., A. Brewis, A. Wutich, and P. B. Udas. 2020. “Sub-

Optimal Household Water Access Is Associated With Greater Risk of

Intimate Partner Violence Against Women: Evidence From Nepal.”

Journal of Water and Health 18, no. 4: 579–594. https:// doi. org/ 10. 2166/

wh. 2020. 024.

Choudhary, N., R. Schuster, A. Brewis, and A. Wutich. 2020. “Water

Insecurity Potentially Undermines Dietary Diversity of Children Aged

6–23 Months: Evidence From India.” Maternal & Child Nutrition 16, no.

2: e12929. https:// doi. org/ 10. 1111/ mcn. 12929 .

Choudhary, N., C. SturtzSreetharan, S. Trainer, etal. 2023. “Managing

Menstruation With Dignity: Worries, Stress and Mental Health in Two

Water- Scarce Urban Communities in India.” Global Public Health 18,

no. 1: 2233996. https:// doi. org/ 10. 1080/ 174 41 692 . 2 023. 2 233996.

Dobbin, K. B., A. L. Fencl, G. Pierce, M. Beresford, S. Gonzalez, and

W. Jepson. 2023. “Understanding Perceived Climate R isks to Household

Water Supply and Their Implications for Adaptation: Evidence From

California.” Climatic Change 176, no. 4: 40. https:// doi. org/ 10. 1007/

s1058 4- 023- 03517 - 0.

du Bray, M. V., R. Stotts, R. Southee, and A. Wutich. 2023. “Beyond

Extreme: Heat E mergency and Water Insecur ity for People Experiencin g

Houselessness in Phoenix, Arizona, USA During and After the

Heatwave of 2023.” Human Ecology 51, no. 5: 799–808. https:// doi. org/

10. 1007/ s1074 5- 023- 00 447 - 4.

Empinotti, V. L., J. Budds, W. Jepson, et al. 2021. “Advancing Urban

Water Security: The Urbanization of Water–Society Relations and

Entry–Points for Political Engagement.” Water International 46, no. 6:

956–968. https:// doi. org/ 10. 1080/ 02508 060. 2021. 1937901.

Ford, L. B., H. J. Bethancourt, Z. S. Swanson, et al. 2023. “Water

Insecu rity, Water Borrowing a nd Psychosocial Str ess Among Daas anach

Pastoralists in Northern Kenya.” Water International 48, no. 1: 63–86.

https:// doi. org/ 10. 1080/ 02508 060. 2022. 2138050.

Frongillo, E. A., H. J. Bethancourt, J. D. Miller, S. L. Young, and

Household Water Insecurity Experiences Scales (HWISE)- Research

Coordinat ion Network (RCN). 2024 . “Identifying Ord inal Categories for

the Water Insecurity Experiences Scales.” Journal of Water Sanitation

and Hygiene for Development 14, no. 11: 1066–1078. https:// doi. org/ 10.

2166/ washd ev. 2024. 042.

Garrick, D., S. Balasubramanya, M. Beresford, etal. 2023. “A Systems

Perspective on Water Markets: Barriers, Bright Spots, and Building

Blocks for the Next Generation.” Environmental Research Letters 18, no.

3: 031001. https:// doi. org/ 10. 1088/ 1748- 9326/ acb227.

Grasham, C. F., R. Calow, V. Casey, etal. 2021. “Engaging With the

Politics of Climate Resilience Towards Clean Water and Sanitation for

all.” npj Clean Water 4, no. 1: 42. https:// doi. org/ 10. 1038/ s4154 5- 021-

00133 - 2.

Hannah, D. M., I. Lynch, F. Mao, J. D. Miller, S. L . Young, and S. K rause.

2020 . “Water and Sanitation for all i n a Pandemic.” Nature Sustainability

3, no. 10: 773–775. https:// doi. org/ 10. 1038/ s4189 3- 020 - 0593- 7.

Harris, L. M., C. Staddon, A. Wutich, etal. 2020. “Water Sharing and

the Right to Water: Refusal, Rebellion and Ever yday Resistance.”

Political Geography 82, no. C. https:// doi. org/ 10. 1016/j. polgeo. 2020.

1022 45.

Jankovic- Rankovic, J., A. Roque, A. Rosinger, etal. 2024. “Household

Water Sharing: Implications for Disaster Recovery and Water Policy.”

Water Security 23, no. 100: 178. https:// doi. org/ 10. 1016/j. wasec. 2024.

100178 .

12 of 14 American Journal of Human Biology, 2025

Jepson, W., P. Tomaz, J. O. Santos, and J. Baek. 2021. “A Comparative

Analysis of Urban and Rural Household Water Insecurity Experiences

During the 2011–17 Drought in Ceará, Brazil.” Water International 46,

no. 5: 697–722. https:// doi. org/ 10. 1080/ 02508 060. 2021. 1944543.

Jepson, W. E., J. Stoler, J. Baek, J. M. Martínez, F. J. U. Salas, and G.

Carrillo. 2021. “Cross- Sectional Study to Measure Household Water

Insecurity and Its Health Outcomes in Urban Mexico.” BMJ Open 11,

no. 3: e040825. https:// doi. org/ 10. 1136/ bmjop en- 2020- 040825.

Kisliuk, N., S. LaPointe, S. L. Young, etal. 2024. “Water Insecurity Is

Associated With Intimate Partner Violence Among Female Adolescents

and Youth but Not Males in Rural Tanzania: A Cross- Sectional Study.”

Global Public Health 19, no. 1: 2409369.

Lemaitre, A. K., J. D. Miller, and J. Stoler. 2023. “Household Water

Insecurity Experiences and Their Perceived Determinants in a Low-

Income Community of Cartagena, Colombia, During a Water Service

Expansion Project.” PLOS Water 2, no. 9: e0000154. https:// doi. org/ 10.

1371/ journ al. pwat. 0000154.

Mao, F., J. D. Miller, S. L. Young, S. Krause, and D. M. Hannah. 2022.

“Inequality of Household Water Security Follows a Development

Kuznets Cur ve.” Nature Communications 13, no. 1: 4525. https:// doi.

org/ 10. 1038/ s4146 7- 022- 31867 - 3.

Meehan, K., M. Beresford, F. Amador Cid, etal. 2023. “Homelessness

and Water Insecurity in the Global North: Trapped in the Dwelling

Paradox .” Wile y Interdisciplinar y Reviews : Water 10, no. 4: e1651. https ://

doi. org/ 10. 1002/ wat2. 1651.

Meehan, K., W. Jepson, L. M. Harris, etal. 2020. “Exposing the Myths

of Household Water Insecurity in the Global North: A Critical Review.”

Wiley Interdisciplinary Reviews: Water 7, no. 6: e1486. https:// doi. org/ 10.

1002/ wat2. 1486.

Miller, J. D., E. A. Frongillo, E. Weke, etal. 2021. “Household Water

and Food Insecurity A re Positively Associated With Poor Mental and

Physical Health Among Adults Living With HIV in Western Kenya.”

The Journal of Nutrition 151, no. 6: 1656–1664. https:// doi. org/ 10. 1093/

jn/ nxab030.

Miller, J. D., J. Vonk, C. Staddon, and S. L. Young. 2020. “Is Household

Water Insecurity a Link Between Water Governance and Well- Being?

A Multi- Site Analysis.” Journal of Water Sanitation and Hygiene for

Development 10, no. 2: 320–334. https:// doi. org/ 10. 2166/ washd ev. 2020.

165.

Mir Mohamad Tabar, S. A., A. Brewis, and M. Sohrabi. 2023. “Status,

Social Norms, or Safet y? Understanding Intended and Reported Bottled

Water Use in Urban Mashh ad, Iran.” Journal of Water and Health 21 , no.

1: 81–93. https:// doi. org/ 10. 2166/ wh. 2022. 319.

Negrón, R., A. Wutich, H. Russell Bernard, etal. 2024. “Ethnographic

Methods: Training Norms and Practices and the Future of American

Anthropology.” American Anthropologist 126, no. 3: 458–469. htt ps: //

doi. org/ 10. 1111/ aman. 13991 .

Octavianti, T., and C. Staddon. 2021. “A Review of 80 Assessment Tools

Measuring Water Security.” Wiley Interdisciplinary Reviews: Water 8,

no. 3: e1516. https:// doi. org/ 10. 1002/ wat2. 1516.

Pearson, A. L., E. A. Mack, A. Ross, etal. 2021. “Interpersonal Conflict

Over Water Is Associated With Household Demographics, Domains

of Water Insecurity, and Regional Conflict: Evidence From Nine Sites

Across Eight Sub- Saharan African Countries.” Water 13, no. 9: 1150.

https:// doi. org/ 10. 3390/ w1309 1150.

Rafa, N., S. M. N. Uddin, and C. Staddon. 2022. “Exploring Challenges

in Safe Water Availability and Accessibility in Preventing COVID- 19 in

Refugee Settlements.” In W icked Problem s of Water Qualit y Governance ,

269–274. Routledge. https:// doi. org/ 10. 1080/ 02508 060. 2020. 1803018.

Rempel, J. L., and K. B. Dobbin. 2024. “When “Symbolic” Policy Is

Anything but: Policy Design and Feedbacks From California's Human

Right to Water Law.” Policy Studies Journal. https:// doi. org/ 10. 1111/ psj.

12564 .

Rhue, S. J., G. Torrico, C. Amuzie, et al. 2023. “ The Effects of

Household Water Insecurity on Child Health and Well- Being.” Wiley

Interdisciplinary Reviews: Water 10, no. 6: e1666. https:// doi. org/ 10.

1002/ wat2. 1666.

Roque, A., D. Pijawka, and A. Wutich. 2020. “The Role of Social Capital

in Resiliency: Disaster Recovery in Puerto R ico.” Risk, Hazards & Crisis

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