Department of Nutritional Sciences, The University of Michigan School of Public Health, Ann Arbor, MI, United States.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
J Nutr. 2023 Nov;153(11):3308-3316. doi: 10.1016/j.tjnut.2023.08.019. Epub 2023 Aug 23.
Tap water distrust and avoidance, indicators of water insecurity, are prevalent in marginalized United States populations. As future environmental challenges stress water resources, further understanding of the scope of water insecurity and its impact on diet quality is needed, particularly in vulnerable United States populations.
To evaluate associations between 3 potential indicators of water insecurity-1) perception of tap water safety for drinking, 2) perception of tap water safety for cooking, and 3) tap water avoidance-and dietary quality and beverage intake in lower-income United States adults.
A cross-sectional, web-based survey was fielded to 1798 lower-income (<250% federal poverty guidelines) United States adults. Participants answered questions detailing tap water safety perceptions and avoidance, beverage intake, dietary intake (30-d prime diet quality score), and sociodemographic covariates. Sociodemographic differences in drinking water insecurity measures were evaluated using chi-square and Fisher-Freeman-Halton tests. Associations between water insecurity measures and dietary outcomes were assessed using generalized linear models adjusted for sociodemographic covariates, and effect modification by sociodemographic covariates was assessed.
Over half of the adults surveyed experienced some aspect of water insecurity. Measures of water security differed significantly by sociodemographic covariates (Ps < 0.05), with higher percentages of women and gender-nonconforming persons, minoritized racial and ethnic groups, lower-income groups, and food-insecure adults reporting indicators of water insecurity. Presence of any water insecurity was associated with lower diet quality (β = -1.07; 95% CI: -2.11, -0.03; P = 0.04), lower tap water intake (relative difference [RD] = 0.35; 95% CI: 1.28, 2.12; P < 0.0001), higher bottled water intake (RD = 1.64; 95% CI: 1.28, 2.12; P = 0.0001), and higher sugar-sweetened beverages intake frequency (frequency ratio = 1.13; 95% CI: 1.01, 1.27; P = 0.03).
Water insecurity indicators are associated with poorer diet quality and beverage intake in a population of United States adults with lower-incomes. Addressing the intersection of water insecurity, food security, environmental impacts, and nutrition may help to improve the well-being and resiliency of vulnerable populations.
自来水不信任和回避，这是水资源不安全的指标，在美国边缘人群中普遍存在。随着未来环境挑战对水资源的压力越来越大，我们需要进一步了解水资源不安全的范围及其对饮食质量的影响，尤其是在美国脆弱人群中。
评估 3 种潜在的水资源不安全指标-1）对饮用水安全的感知，2）对饮用水安全的烹饪的感知，以及 3）对自来水的回避-与低收入美国成年人的饮食质量和饮料摄入之间的关联。
对 1798 名低收入（<250%联邦贫困线）的美国成年人进行了一项基于网络的横断面调查。参与者回答了有关自来水安全感知和回避、饮料摄入、饮食摄入（30 天主要饮食质量评分）和社会人口统计学协变量的问题。使用卡方检验和 Fisher-Freeman-Halton 检验评估了不同社会人口统计学变量的饮用水不安全措施之间的差异。使用调整了社会人口统计学协变量的广义线性模型评估了水不安全措施与饮食结果之间的关联，并评估了社会人口统计学协变量的效应修饰作用。
超过一半的被调查成年人经历了某种程度的水不安全。水安全措施因社会人口统计学协变量而异（P<0.05），女性和性别非传统者、少数族裔和种族群体、低收入群体和食物不安全的成年人报告水不安全指标的比例较高。任何水不安全的存在与较低的饮食质量相关（β=-1.07；95%置信区间：-2.11，-0.03；P=0.04），较低的自来水摄入量（相对差异[RD]=0.35；95%置信区间：1.28，2.12；P<0.0001），更高的瓶装水摄入量（RD=1.64；95%置信区间：1.28，2.12；P=0.0001）和更高的含糖饮料摄入频率（频率比=1.13；95%置信区间：1.01，1.27；P=0.03）。
在美国低收入成年人中，水不安全指标与较差的饮食质量和饮料摄入有关。解决水资源不安全、粮食安全、环境影响和营养之间的交叉问题，可能有助于改善弱势群体的福祉和适应能力。
