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

Water insecurity (WI) is an underappreciated issue in the United States. 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 (n = 18,252), we describe nationally representative trends and racial/ethnic disparities in WI and FI. Between 2005 and 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% confidence interval, 3.0–6.1) to 10.3% (8.4–12.1; P < 0.001). Compared with 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. US children who avoid tap water, a proxy for water insecurity, were more likely to experience household food insecurity than those who did not. Concurrent water and food insecurity doubled between 2005 and 2020 with considerable racial/ethnic disparities.