The intersection of tap water avoidance, food insecurity, and sugar-sweetened beverage intake among US 2-17-year-olds.

Abstract

Objective: This study assessed how the intersection of water insecurity (WI) and food insecurity (FI) is associated with sugar-sweetened beverage (SSB) intake among US children and adolescents.

Methods: Data from 18,251 children in the cross-sectional 2005-2020 National Health and Nutrition Examination Survey were analyzed in 2024-25. Differences in consumption of any SSB, mean SSB kcal, and percent of total kcals from SSBs on a given day across a validated four-category variable of WI (based on tap water avoidance) and FI (using the US Food Security Survey Module) were assessed with log-binomial and linear regressions.

Results: Compared to children with water security (WS) and food security (FS), children with WI & FS had 13% (95% CI: 1.06-1.19; P<0.001) higher prevalence ratio of consuming any SSB, consumed 23.3 more kcals (SE=6.7; P=0.001), and 1.1% (SE=0.3; P<0.001) more total kcals from SSBs. Children with WS & FI had 7% (95% CI: 1.02-1.12; P=0.002) higher prevalence ratio of drinking any SSB, consumed 13.2 (SE=5.1; P=0.01) more kcals, and 0.8% (SE=0.2; P=0.001) more of their total kcals from SSBs. Children experiencing WI & FI had 15% (95% CI: 1.08-1.22; P<0.001) greater prevalence ratio of SSB intake, consumed 36.1 more kcals (SE=13.9; P=0.01), and 1.8% (SE=0.4; P<0.001) more of their total kcals from SSBs.

Conclusion: Children experiencing WI or FI alone had higher SSB intake compared to children who were WS and FS; children experiencing both WI and FI had the highest SSB intake. Addressing the intersection of WI and FI may help reduce SSB intake.