Trends and disparities in concurrent tap water avoidance and household food insecurity among US children

Water insecurity (WI) is an underappreciated issue in the US. WI co-occurs with food insecurity (FI), but little work has explored the Water-Food nexus experienced by children. Drawing on individual tap water avoidance, a proxy of WI, and prior-year household food security data from 2-17 year-olds in the National Health and Examination Survey (NHANES) (n=18,252), we describe nationally-representative trends and racial/ethnic disparities in WI and FI. Between 2005-2020, this WI proxy was associated with higher probability of FI with heterogeneity by race/ethnicity and income, and concurrent WI and FI more than doubled from 4.6% (95% CI, 3.0-6.1) to 10.3% (8.4-12.1; P<0.001). Compared to White children, children identifying as Black and Hispanic had 3.5 (2.6-4.7; P<0.001) and 7.1 (5.4-9.3; P<0.001) times the relative-risk ratios of experiencing concurrent WI and FI. The increasing prevalence of US children experiencing concurrent WI and FI alongside observed racial/ethnic disparities is of major public health concern.