PROJECT SUMMARY
As Kamala Harris proclaimed in June 2022 when she launched the White House Action Plan on Water
Security, the global water crisis is among the most urgent issues of our time. Water insecurity, or the lack of
stable access to safe and acceptable water, has been identified as a threat to human well-being that is
plausibly on par with that of food insecurity. Further, emerging evidence suggests that the impacts of water
insecurity are surprisingly far-reaching, including suboptimal nutrition, physical health, and mental health. We
are, however, early on in our understanding of the role of water insecurity in human health, in part because we
have lacked precise measures of water insecurity. Therefore, the core scientific objective of this R03
application is to understand the roles of water and food insecurity experiences on key health outcomes
among a nationally representative sample of Mexican adults from Mexico's 2021 National Health and Nutrition
Survey [Encuesta Nacional de Salud y Nutrición (ENSANUT)]. Our central hypothesis is that water insecurity
will be negatively associated with health measures, even when controlling for known key covariates. In Aim 1,
we will investigate the associations between water insecurity and indicators of nutrition (intake of sugar-
sweetened beverages, ultra-processed foods, fruits, vegetables), physical health (adiposity, blood pressure,
diabetes), and mental health (depressive symptomatology). In Aim 2, we will examine if concurrent water and
food insecurity have a synergistic (multiplicative) relationship with health measures, i.e., if those experiencing
both insecurities have worse health than expected from the additive associations with water and food
insecurity. Increasing our knowledge about how water insecurity shapes health is highly significant because
global problems with water quantity (both flooding & shortages) and quality are occurring with increasing
frequency and severity due to climate change, population growth, and crumbling infrastructure. This project is
innovative for its precise measurement of water insecurity. Before 2019, global indicators of water captured
only the physical availability of water or water infrastructure; these are far more distal predictors of human
health. It is also innovative because ENSANUT 2021 is the first national health and nutrition survey in which
experiences of water insecurity have been measured. Finally, the concurrent measurement of water and food
insecurity will bring unprecedented insights into their potential synergisms in North America. Expected
outcomes include a clearer picture of the epidemiology of water insecurity in Mexico and a more precise
understanding of how experiences with problematic water access, use, and stability can act as barriers to
optimal health. This information will likely reveal novel ways to intervene to reduce resource inequities and the
risk of poor health outcomes among vulnerable populations. This work will also set the precedent for inclusion
of experiential measures of water insecurity in other large nutrition and health surveys in low-, middle-, and
high-income countries, including the US.