The Intersection of Tap Water Avoidance, Food Insecurity, and Sugar-Sweetened Beverage Intake Among U.S. Children and Adolescents Aged 2-17 Years.

Abstract

This study assessed how the intersection of water insecurity and food insecurity is associated with sugar-sweetened beverage intake among U.S. children and adolescents. Data from 18,251 children in the cross-sectional 2005-2006 through 2017-2020 National Health and Nutrition Examination Survey waves were analyzed in 2024-2025. Differences in the consumption of any sugar-sweetened beverage, mean sugar-sweetened beverage kilocalorie, and percent of total kilocalories from sugar-sweetened beverages on a given day across a validated 4-category variable of water insecurity (based on tap water avoidance) and food insecurity (using the U.S. Food Security Survey Module) were assessed with log-binomial and linear regressions. Compared with children with water security and food security, children with water insecurity and food security had a 13% (95% CI=1.06, 1.19; p<0.001) higher prevalence ratio of consuming any sugar-sweetened beverage, consumed 23.3 more kilocalories (SE=6.7; p=0.001), and consumed 1.1% (SE=0.3; p<0.001) more total kilocalories from sugar-sweetened beverages. Children with water security and food insecurity had a 7% (95% CI=1.02, 1.12; p=0.002) higher prevalence ratio of drinking any sugar-sweetened beverage, consumed 13.2 (SE=5.1; p=0.01) more kilocalories, and consumed 0.8% (SE=0.2; p=0.001) more of their total kilocalories from sugar-sweetened beverage. Children experiencing water insecurity and food insecurity had a 15% (95% CI=1.08, 1.22; p<0.001) greater prevalence ratio of sugar-sweetened beverage intake, consumed 36.1 more kilocalories (SE=13.9; p=0.01), and consumed 1.8% (SE=0.4; p<0.001) more of their total kilocalories from sugar-sweetened beverages. Children experiencing water insecurity or food insecurity alone had higher sugar-sweetened beverage intake than children who had water security and food security, with children experiencing both water insecurity and food insecurity having the highest sugar-sweetened beverage intake. Addressing the intersection of water insecurity and food insecurity may help reduce sugar-sweetened beverage intake.