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Cash Water Expenditures Are Associated with Household Water Insecurity, Food Insecurity, and Perceived Stress in Study Sites across 20 Low- and Middle-Income Countries


Stoler, Justin; Pearson, Amber L.; Staddon, Chad; Wutich, Amber; Mack, Elizabeth; Brewis, Alexandra; Rosinger, Asher Y.; Adams, Ellis; Ahmed, Jam Farooq; & Alexander, Mallika, et al. (2020). Cash Water Expenditures Are Associated with Household Water Insecurity, Food Insecurity, and Perceived Stress in Study Sites across 20 Low- and Middle-Income Countries. Science of The Total Environment, 716, 135881.


Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.


Reference Type

Journal Article

Journal Title

Science of The Total Environment


Stoler, Justin
Pearson, Amber L.
Staddon, Chad
Wutich, Amber
Mack, Elizabeth
Brewis, Alexandra
Rosinger, Asher Y.
Adams, Ellis
Ahmed, Jam Farooq
Alexander, Mallika
Balogun, Mobolanle
Boivin, Michael
Carrillo, Genny
Chapman, Kelly
Cole, Stroma
Collins, Shalean M.
Escobar-Vargas, Jorge
Freeman, Matthew
Asiki, Gershim
Ghattas, Hala
Hagaman, Ashley K.
Jamaluddine, Zeina
Jepson, Wendy
Maes, Kenneth
Mathad, Jyoti
Mbullo, Patrick
Melgar-Quiñonez, Hugo
Miller, Joshua
Niesluchowski, Monet
Omidvar, Nasrin
Samayoa-Figueroa, Luisa
Sánchez-Rodríguez, E. Cuauhtemoc
Santoso, Marianne V.
Schuster, Roseanne C.
Sullivan, Andrea
Tesfaye, Yihenew
Triviño, Nathaly
Trowell, Alex
Tshala-Katumbay, Desire
Tutu, Raymond A.
Young, Sera L.
Zinab, Hassan

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