What happens to beverage consumption habits when tap water is not readily available 24/7? A team led by Brisa N. Sánchez, PhD, a professor and associate dean, and Doctoral Research Fellow Juan Carlos Figueroa Morales, both in the Dornsife School of Public Health, used nationally representative survey data on beverage habits from Mexico’s 2022 Encuesta Nacional de Salud y Nutrición, to glean new insights between frequency of water supply access and beverage choices among adults in Mexico.
The team’s recently published paper inThe Journal of Nutrition, is to our knowledge, the first study to look at intermittent water access (less than continuous 24 hour-a-day access) and beverage consumption.
Respondents were grouped into three categories: those who, relative to other beverages, drink more water (roughly half of the population at 48.4%), those who drank more industrialized beverages, such as soda or processed fruit nectars (26%), or those who consumed mostly beverages prepared at home, such as coffee or tea (25.5%).
Compared to those who had continuous access to drinkable tap water, the team found that those experiencing daily intermittent water supply were more likely to drink higher amounts of industrialized beverages than water, and thereby may be at higher risk of chronic diseases.
The findings are particularly relevant here in the United States where roughly 46 million people lack continuous access to running water that is safe to drink. Below, we check in with Sánchez andFigueroa about what these findings say about the importance of access to clean tap water and what piped water suppliers can do to restore trust with those that do not currently feel confident about drinking tap water.
Did anything surprise you about these findings?
Sánchez: We used a statistical technique called latent class analysis to organize consumption of many beverage categories into beverage patterns. We were happily surprised to see that the patterns found in the data had intuitive interpretations (i.e., their content validity is high), and thus they can be useful to illustrate general beverage consumption. Our finding that intermittent water supply was associated with beverage consumption patterns that tend to favor industrialized beverages was not surprising as it matches the results of a qualitative, ethnographic study conducted prior to our analysis by members of our research team. This quantitative study conducted nationwide in Mexico thus confirmed hypotheses that arose from ethnographic observations.
Roughly half a million U.S. households lack access to indoor plumbing and continuous tap water. Unsafe levels of lead in water have been found in water in Flint, Michigan, Jackson, Mississippi and other places in the U.S. Based on the findings from your paper, what are some of the downstream health risks posed by this lack of infrastructure?
Sánchez: Our study shows that intermittent water supply, one indicator of poor infrastructure or insufficient water, was associated with greater likelihood of industrialized sugar sweetened beverage (SSB) consumption. SSB consumption is well known to be associated with chronic disease including obesity and several other metabolic disorders. Thus, lack of water infrastructure has the potential to influence chronic disease risk. While our study does not directly quantify the link between intermittent water supply and chronic disease risk, our study opens new areas of research (besides the previously known relationship with infectious diseases) that may further highlight the importance of water infrastructure.
Recent data suggests that 61.4 million Americans don’t drink their clean tap water at all. What are some of the factors that erode this trust and what are some ways to restore confidence in tap water?
Sánchez: Our prior ethnographic study showed that distrust in water infrastructure was seeded in Mexico by public service announcements following disasters (e.g., the public must boil water after Mexico’s City’s 1985 earthquake), and subsequently, the widespread beliefs that the infrastructure is failing have led people to believe tap water is unfit to drink. Also, people are very aware of any change in the water they are receiving, such as changes in color, smell and taste. These changes, even if small, reinforce distrust. Unfortunately, broken trust is hard to restore. To restore trust in tap water, it is important to prioritize transparency and infrastructure upgrades, and community engagement.
Figueroa: Clear communication about water quality, swift responses to contamination and accessible public data may help build confidence. Involving communities in decision-making and ensuring equitable access to safe water are also key. Independent testing, partnerships with health organizations and visible investments in modernizing water systems may further reinforce public trust.
Why is clean tap water so important for a country to invest in?
Figueroa: Clean tap water is a cornerstone of public health. The importance of clean water has been demonstrated many times over given its influence on infectious disease, and even economic productivity and social equity.
Sánchez: Our study further shows the potential to also influence other areas of health, including beverage consumption and potential downstream chronic disease. As water scarcity increases, having adaptable water infrastructure, that can adapt to increases in the frequency of droughts and extreme weather events will be critically important to support public health. It is also worth noting that infrastructure that supports clean tap water is broader than the water pipes in our home or cities, but also may extend to broader water and land management practices. So, investment in water infrastructure is a broader issue of how we organize around the provision of an essential resource. Existing (and investment in) infrastructure and land and water management more broadly may serve as a buffer under unavoidable scarcity conditions (such as those posed by droughts and extreme weather events).
Anything else I should have asked?
Figueroa: Typically, households with a lower socioeconomic status (SES) are the ones that have the worst access to water. We also need to raise questions about who is getting or not getting water to provide equitable access in a vulnerable context (such as the one posed by increasing water scarcity).
Reporters interested in talking with Sánchez or Figueroa should contact Greg Richter, assistant director of media relations at gdr33@drexel.edu or 215-895-2614.
