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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; Balogun, Mobolanle; Boivin, Michael; Carrillo, Genny; Chapman, Kelly; Cole, Stroma; Collins, Shalean M.; Escobar-Vargas, Jorge; Freeman, Matthew; Asiki, Gershim; Ghattas, Hala; Hagaman, Ashley; 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


Justin Stoler

Amber L. Pearson

Profile Image

Chad Staddon
Professor/Associate Head of Department: Research and Scholarship

Amber Wutich

Elizabeth Mack

Alexandra Brewis

Asher Y. Rosinger

Ellis Adams

Jam Farooq Ahmed

Mallika Alexander

Mobolanle Balogun

Michael Boivin

Genny Carrillo

Kelly Chapman

Stroma Cole
Senior Lecturer in Human Geography

Shalean M. Collins

Jorge Escobar-Vargas

Matthew Freeman

Gershim Asiki

Hala Ghattas

Ashley Hagaman

Zeina Jamaluddine

Wendy Jepson

Kenneth Maes

Jyoti Mathad

Patrick Mbullo

Hugo Melgar-Quiñonez

Joshua Miller

Monet Niesluchowski

Nasrin Omidvar

Luisa Samayoa-Figueroa

E. Cuauhtemoc Sánchez-Rodríguez

Marianne V. Santoso

Roseanne C. Schuster

Andrea Sullivan

Yihenew Tesfaye

Nathaly Triviño

Alex Trowell

Desire Tshala-Katumbay

Raymond A. Tutu

Sera L. Young

Hassan Zinab


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.

Journal Article Type Article
Journal Science of The Total Environment
Print ISSN 0048-9697
Electronic ISSN 1879-1026
Publisher Elsevier
Peer Reviewed Peer Reviewed
Article Number 135881
APA6 Citation Stoler, J., Pearson, A. L., Staddon, C., Wutich, A., Mack, E., Brewis, A., …Zinab, H. (in press). 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,
Keywords Environmental Engineering; Waste Management and Disposal; Pollution; Environmental Chemistry