Food insecurity is a well-recognized and understood concept, yet the idea of water insecurity, especially in high-income countries, is not often considered. Because water insecurity has not been the focus of much research attention, we know little about its impact upon health and well-being. Recently developed approaches to measure water insecurity are now making the study of this phenomenon possible. In an article published in the May 2022 issue of The Journal of Nutrition, Rosinger reports on a study conducted using NHANES data to estimate water avoidance.

Data from over 32,000 adults in the 2005-2018 NHANES data set were used to measure: 1) total water intake, 2) the sum of tap and bottled water (plain), 3) tap, and 4) bottled water. Those data were used to calculate the percentage of individuals that do not consume tap water and only consume bottled water. The relationships between tap water avoidance and plain water intake or sugar-sweetened beverage consumption were determined. Receiver operating characteristics (ROC) curves were used to test the predictive accuracy of the observations.

The increase in plain water consumption in these data was driven by an increase in bottled water intake. More than a third of people only consumed bottled water, and more than half did not drink tap water on a routine basis. Those who avoided tap water or plain water consumed more bottled water and sugar-sweetened beverages. These data led Rosinger to conclude that water intake variables present in dietary recalls can be used to predict tap water avoidance, which is an indicator of water insecurity and public concerns about tap water.

In an editorial, Young and Miller, discuss how water security is not an apparent issue in the U.S. when observations are made for the entire country. However, when data are disaggregated, there are large disparities across regions of the U.S., and among race and income levels. They concur it is possible to use proxy indicators to estimate tap water avoidance and water insecurity, and the observation that avoiding tap water is associated with sugar-sweetened beverages has significant health implications. They suggest more work around the issue of water insecurity is needed if we are to appreciate its impact on health and well-being.


Asher Y Rosinger, Using Water Intake Dietary Recall Data to Provide a Window into US Water Insecurity, The Journal of Nutrition, Volume 152, Issue 5, May 2022, Pages 1263–1273,

Sera L Young, Joshua D Miller, Water Insecurity in the United States: Quantifying an Invisible Crisis, The Journal of Nutrition, Volume 152, Issue 5, May 2022, Pages 1183–1184,

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