A novel tool for the cross-cultural assessment of household-level water insecurity: scale refinement, validation, and manual development

Household food insecurity has emerged as a powerful predictor of a range of poor nutrition and health outcomes. Household water insecurity (HHWI), i.e. the ability to reliably access water in sufficient quantity and quality, may be equally or more powerfully predictive of adverse health outcomes as food insecurity has been. Strikingly, the role of household water insecurity has been almost entirely overlooked. In fact, be-cause there is currently no validated scale for assessing household water insecurity (HHWI) across various cultural and ecological settings, it has not been possible to measure HHWI, compare levels across settings, or understand how HHWI impacts agricultural, nutrition, and health. We will work to develop such a scale collaboratively, with institutions in the United States and Kenya, and scholars at research locations in Bangladesh, Brazil, Guatemala, Nepal, and Tajikistan. Our team of investigators have expertise spanning agriculture, nutrition, anthropology, medicine, epidemiology, behavioral sciences, and sanitation. The central hypothesis is that HHWI negatively impacts nutritional status, in ways distinct from food insecurity. We propose to explore a variety of mechanisms by which this may occur, including decreased agricultural production, financial and opportunity costs, time and energy expenditure, and anxiety and stress.