Tap Water Consumption and Perceptions in United States Latinx Adults

Exploring barriers and facilitators to water availability and accessibility, and potential strategies for improving water accessibility and children's intake in family childcare homes: a qualitative study

Background

Children in the U.S. drink too little water and too much juice and sugar sweetened beverages. Inadequate access to drinking water in locations where children spend substantial time, like family childcare homes (FCCH) could play a role in low child water intake. The aim of this qualitative study was to explore barriers and facilitators to water availability and accessibility in FCCH, and determine potential strategies for facilitating water accessibility and children's intake in FCCH.

Methods

We conducted virtual interviews, in Spanish and/or English, with family child care providers (FCCP) from Rhode Island, Connecticut, and Massachusetts. Interviews were conducted by University of Connecticut graduate students, including two who were fluent in Spanish and English. These were audio-recorded, transcribed verbatim, and translated to English. We conducted a deductive analysis using a priori themes. Additional codes were developed and applied to capture emerging themes from the qualitative data.

Results

Twenty FCCP (100% identified as female; 50% as Latina) participated in the interviews. FCCP barriers to water availability at FCCH included focus on other beverages, e.g., milk; confusion with the Child and Adult Care Food Program (CACFP) guidelines regarding water, and concerns about: water quality, mess, children eating enough food/milk, bathroom accidents, and cost for filters/bottled water. Barriers to children drinking water included: children not liking or preferring water, parental preferences/role modeling, and parental concerns about water quality. Suggested potential strategies to facilitate water access and intake included water filters to ensure safe water access, self-serving stations and water bottles to encourage autonomy among children, and incorporating water into daily routines. Participants also favored materials and activities to educate and encourage children to drink water and to keep track of their intake.

Conclusion

These findings suggest that interventions to increase water consumption at FCCH should provide resources to guarantee safe water access to children, encourage children to drink water, and help clarify misperceptions and confusion around CACFP beverage guidelines. Future research should evaluate the effectiveness of interventions to provide education and water access resources to FCCP and families on improving child water access, availability and intake.

Innovative microbial water quality management in water distribution systems using in-pipe hydropowered UV disinfection: envisioning futuristic water-energy systems

Hydropower UV disinfection has not been explored as a possible alternative for off-grid disinfection. Hydropowered UV LED technology was developed using off-the-shelf UV-C LEDs and pico - and femto-scale hydro turbine generators and evaluated across point-of-use relevant flow rates. Commercially available UV LED flow through reactors were subjected to microorganism challenge testing with 3 power schemes: wall-plug, hydropower, and hydropower-charged battery. UV LEDs powered by hydropower-charged battery demonstrated similar disinfection as wall-plug powered UV LEDs, achieving 0.5-1.8 MS2 log10 reduction at flow rates 0.5-2.3 L min-1, corresponding to reduction equivalent doses (RED) up to 16 or 30 mJ/cm2 for 254 and 285 nm, respectively. With hydropowered UV LEDs alone, MS2 log10 reduction decreased to <0.3 log10 reduction due to an underperforming and grossly inefficient turbine, with RED of 8 or 18 mJ/cm2 for 254 and 285 nm, respectively. Assessment of existing markets of UV disinfection systems and pico-hydro turbines demonstrated that hydropowered UV systems are already theoretically feasible for scales at point-of-entry (POE) and above. Economic feasibility will improve if turbines and/or UV system efficiencies improve. Prototype hydropower UV LED systems ranged from $145 to 220 depending on the UV LED reactor, and the battery system added $81. This study demonstrates the practicality of sustainable, renewable energy POU UV disinfection technology that can benefit decentralised, off-grid, rural and remote communities. The system may also scale up to provide renewable energy disinfection at larger scales, such as buildings and water distribution systems, for protecting human health in highly populated areas.

Sustainable HEalthy Diet practices: a cross-sectional analysis of an adult Greek sample

BACKGROUND

Sustainable nutrition is based on foods with a low environmental impact, accessible and affordable, ensuring protection of the biodiversity, while including the cultural elements of each geographical region. The present cross-sectional study aimed to evaluate adherence to a sustainable diet and the perceived environmental benefit of adopting a sustainable diet among adults in Greece.

METHODS

The Sustainable HEalthy Diet (SHED) questionnaire evaluated sustainable nutrition practices and awareness in a sample of 607 adult Greeks recruited through social media.

RESULTS

A positive association was revealed between healthy eating, a plant-based diet and organic awareness. Healthy eating was related to the consumption of low-salt and low-sugar products, avoiding added salt and ultra-processed foods (UPFs), as well as limiting sweets and soft drinks. Most participants (94.6%) were flexitarians, consuming meat instead of plant-based foods, although showing a preference for legumes over meat products. Most (86.8%) failed to meet the 5-a-day recommendations for fruit and vegetables, which were bought mainly from supermarket chains, with men resolving to electronic commerce purchases, while women preferring small, local grocery shops. Most responders consumed tap water (54.9%) and homemade meals daily (75.0%). Many participants (32.8%) reported separating and recycling food scraps at home, using neighborhood composters. When organic produce was selected, this involved mainly fruits and vegetables. Between men and women, the latter adopted a plant-based diet to a greater extent, consumed fewer soft drinks, were keener to consume local produce, limit meat intake and eat crops that are pesticide- and herbicide-free. Overall, Greek consumers show preference to local products. Most of them fail to compost and cut down on meat intake. The tool's internal consistency measured by Cronbach alpha was 0.702 and 0.736 for the healthy eating and sustainable eating domains respectively, 0.798 for the environmental domain, while the other domains had lower scores due to contradictory questions. Our Confirmatory Factor Analysis (CFA) demonstrated a good fit (CFI = 0.896, TLI = 0.87) with strong positive relationships between healthy eating, a plant-based diet and organic awareness.

CONCLUSIONS

The results indicate that adult Greeks more easily implement some aspects of sustainable nutrition (organic, local foods), while others appear more difficult (compost, reduce meat intake). Nonetheless, the results can be useful in designing interventions to increase dietary sustainability awareness among Greeks, including educational programs and improved infrastructures.

Opportunities in Programs and Policies to Address the Underlying Drivers of Sugary Drink and Water Consumption in the Washington, DC, Metro Area: A Qualitative Community-Based System Dynamics Approach

BACKGROUND

Although the Dietary Guidelines for Americans recommend that individuals drink water instead of sugar-sweetened beverages (SSBs), this behavior is influenced and reinforced by a complex network of structures and systems.

OBJECTIVE

The objectives of this study were to develop a shared understanding among multiple stakeholders about the structural and underlying, interconnected drivers of SSB and water consumption in the Washington, DC, metro area and to have them identify feasible and influential policy levers.

DESIGN

A community-based system dynamics approach was used during a 2-day group model building workshop where stakeholders engaged to develop a shared visual representation of the underlying, interconnected drivers of SSB and water intake and to identify what they believed were influential and feasible policy levers.

PARTICIPANTS/SETTING

Stakeholders were purposively recruited from diverse sectors (early childhood education [n = 6], nutrition assistance programs [n = 2], food policy council and advocacy groups [n =4], city government officials including municipal water [n = 4], and food and beverage retail [n = 1]) to participate in a group model building workshop during July 2022 in Washington, DC.

STATISTICAL ANALYSIS

Using member checking and iterative feedback, the research team synthesized the outputs from the workshop into 1 causal loop diagram and ranked policy levers.

RESULTS

Stakeholders visualized 7 subsystems that drive water and SSB consumption, then identified and ranked 5 policy levers by potential impact and ease of implementation, including increase public health spending (high impact/hard to do); invest in new and updated infrastructure for public water (high impact/hard to do); implement coordinated public health campaigns to promote drinking safe, palatable water as an alternative to SSB (low impact/easy to do); provision of tap water filters (low impact/easy to do); and limits on SSB marketing (high impact/debated easy or hard to do).

CONCLUSIONS

This participatory approach allowed stakeholders to envision multiple places to intervene in the system simultaneously to both decrease SSB and increase water consumption in the specific context of their community.

Examining disparities in PFAS plasma concentrations: Impact of drinking water contamination, food access, proximity to industrial facilities and superfund sites

BACKGROUND

Most of the US population is exposed to per- and polyfluorinated substances (PFAS) through various environmental media and these sources of PFAS exposure coupled with disproportionate co-localization of PFAS-polluting facilities in under-resourced communities may exacerbate disparities in PFAS-associated health risks.

METHOD

We leveraged two cohorts in Southern California with 8 PFAS concentrations measured in plasma. We obtained PFAS water testing data from the Third Unregulated Contaminant Monitoring Rule and state monitoring data, census tract-level information on food access using the Food Access Research Atlas, the location of Superfund sites on the National Priorities List, and data on facilities known to release PFAS pollutants. These data were then spatially linked to the participants' home addresses.

RESULTS

In the first cohort, we found that detections of PFOS, PFOA, and PFHxS in drinking water were associated with 1.54 ng/mL (95% CI: 0.77, 2.32), 0.47 ng/mL (0.25, 0.68), and 1.16 ng/mL (0.62, 1.71) increase in plasma PFOS, PFOA, and PFHxS. The presence of Superfund sites was associated with higher plasma concentrations of PFOS, PFHxS, PFPeS, and PFHpS (betas [95% CIs]: 0.96 [0.21, 1.71], 0.9 [0.22, 1.58], 0.04 [0.02, 0.06] and 0.05 [0.02, 0.09], respectively). Each additional PFAS-polluting facility present in the neighborhood was associated with a 0.9 ng/mL (0.03, 0.15) increase in the concentration of PFOS. In the other cohort, we found that the presence of Superfund sites was associated with higher plasma PFDA, PFHpS, PFOS (betas [95% CIs]: 0.03 [0.01, 0.06], 0.05 [0.01, 0.09], and 1.96 [0.31, 3.62]). Neighborhood low access to food was associated with a 2.51 ng/mL (0.7, 4.31) increase in plasma PFOS, 0.6 ng/mL (0.16, 1.06) increase in plasma PFOA and 0.06 (0.02, 0.1) increase in plasma PFHpS.

CONCLUSION

Reducing sources of PFAS exposure in under-resourced neighborhoods may help reduce disparities in human exposure levels.

Association Between Child Sugary Drink Consumption and Serum Lipid Levels in Electronic Health Records

Sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption may promote lipid abnormalities in childhood. We examined the association between SSB/FJ intake and lipid levels using electronic health record data for 2816 adolescents. Multivariable logistic regression models treated clinical cutpoints for abnormal lipid levels (triglycerides [TG], high-density lipoprotein (HDL), low-density lipoprotein [LDL], and total cholesterol) as dependent variables. In models not adjusted for adiposity, elevated SSB and FJ consumption was associated with increased odds of having abnormally high TG (SSB: odds ratio [OR] = 1.28 (95% confidence interval [CI] = [1.07-1.52], P = .007); FJ: 1.35 ([1.09-1.69], P = .007)) and abnormally low HDL (SSB: 1.47 ([1.17-1.86], P = .001); FJ: 1.35 ([1.02-1.78], P = .03)). Adjusting for adiposity, a likely mediator of the relationship, attenuated these associations. These findings support the need for identifying unhealthy beverage consumption habits during childhood health care visits as a modifiable behavior associated with cardiometabolic risk.

Shared Perceptions on Upstream Factors that Influence Water and Sugar-Sweetened Beverage Consumption Among Hispanic Families in the Greater Washington, DC, Metro Area: Qualitative Results From Focus Group Discussions

BACKGROUND

Hispanics in the United States are among those with highest consumption of sugar-sweetened beverages (SSBs) and lowest consumption of water. These dietary disparities are rooted in systemic influences that must be identified and addressed.

OBJECTIVE

The study aimed to describe how Hispanic parents currently living in the greater Washington, DC, metro area and born outside of the United States, perceived upstream factors that influenced their current beverage choice.

DESIGN

Six qualitative focus groups were conducted in Spanish in 2021.

PARTICIPANTS/SETTING

Hispanic parents (n = 31) of children enrolled in Early Head Start in the greater Washington, DC, metro area were recruited (all women, born outside the United States, and spoke Spanish as a first language).

STATISTICAL ANALYSIS

Verbatim transcripts were analyzed deductively using the Community Energy Balance Framework.

RESULTS

The five key findings were: Growing up (in their countries of origin in Central America and Mexico) participants were used to drinking water, often gathered it from the source, and liked its flavor. Relatives passed down their knowledge about potabilization of water, the health benefits of drinking water, and health consequences of drinking SSBs. Growing up, prepackaged SSBs were not as accessible compared with where they now live in the United States. Participants perceived that sociocultural hospitality norms dictated that guests should be served SSBs and not water. Participants noted that messages regarding juice and water across US public health programs and policies were not aligned.

CONCLUSIONS

These findings suggest there are opportunities for public health messaging and procurement of safe, palatable drinking water in lieu of SSBs and juice.

Do Mindful Eating and Intuitive Eating Affect Beverage Preferences? A Cross-Sectional Survey

Intuitive eating involves following body signals to guide eating decisions and avoiding restrictive diets. Mindful eating is paying full attention to sensory experiences and fostering nonjudgmental awareness. We aimed to elucidate potential relationships between beverage intake and intuitive and mindful eating scores. This cross-sectional exploratory study (October 2021-December 2022) enrolled adult male and female participants who provided sociodemographic and health-related information and subsequently completed the Beverage Intake Questionnaire, the Mindful Eating Questionnaire (MEQ-30), and the Intuitive Eating Scale (IES-2). Bidirectional relationships were observed between beverage intake and intuitive and mindful eating scores. The total beverage intake of males was double compared with that of females, with the intake being mainly derived from sugar-sweetened beverages (p = 0.000). Increased total water intake was positively correlated with IES-2 and its subscale scores and was negatively correlated with MEQ-30 scores in both sexes (p < 0.05). Alcoholic beverage intake was associated with reductions in IES-2 and MEQ-30 scores, whereas unconditional permission to eat increased by 18.3% in males. In females, the consumption of milk-based beverages decreased the IES-2 scores. Understanding the complex relationships between beverage intake and intuitive and mindful eating may deepen our understanding of individual dietary behaviors and inform dietary interventions.

Water Insecurity Indicators Are Associated with Lower Diet and Beverage Quality in a National Survey of Lower-Income United States Adults

BACKGROUND

Tap water distrust and avoidance, indicators of water insecurity, are prevalent in marginalized United States populations. As future environmental challenges stress water resources, further understanding of the scope of water insecurity and its impact on diet quality is needed, particularly in vulnerable United States populations.

OBJECTIVES

To evaluate associations between 3 potential indicators of water insecurity-1) perception of tap water safety for drinking, 2) perception of tap water safety for cooking, and 3) tap water avoidance-and dietary quality and beverage intake in lower-income United States adults.

METHODS

A cross-sectional, web-based survey was fielded to 1798 lower-income (<250% federal poverty guidelines) United States adults. Participants answered questions detailing tap water safety perceptions and avoidance, beverage intake, dietary intake (30-d prime diet quality score), and sociodemographic covariates. Sociodemographic differences in drinking water insecurity measures were evaluated using chi-square and Fisher-Freeman-Halton tests. Associations between water insecurity measures and dietary outcomes were assessed using generalized linear models adjusted for sociodemographic covariates, and effect modification by sociodemographic covariates was assessed.

RESULTS

Over half of the adults surveyed experienced some aspect of water insecurity. Measures of water security differed significantly by sociodemographic covariates (Ps < 0.05), with higher percentages of women and gender-nonconforming persons, minoritized racial and ethnic groups, lower-income groups, and food-insecure adults reporting indicators of water insecurity. Presence of any water insecurity was associated with lower diet quality (β = -1.07; 95% CI: -2.11, -0.03; P = 0.04), lower tap water intake (relative difference [RD] = 0.35; 95% CI: 1.28, 2.12; P < 0.0001), higher bottled water intake (RD = 1.64; 95% CI: 1.28, 2.12; P = 0.0001), and higher sugar-sweetened beverages intake frequency (frequency ratio = 1.13; 95% CI: 1.01, 1.27; P = 0.03).

CONCLUSIONS

Water insecurity indicators are associated with poorer diet quality and beverage intake in a population of United States adults with lower-incomes. Addressing the intersection of water insecurity, food security, environmental impacts, and nutrition may help to improve the well-being and resiliency of vulnerable populations.

Status, social norms, or safety? understanding intended and reported bottled water use in Urban Mashhad, Iran

Personal plastic-bottled water use is highly commodified, raising an array of cost and environmental concerns, and continues to grow globally. Studies in lower-income nations suggest safety as a primary motivation for such water purchases, but studies in high-income nations with greater relative affordability suggest it is more tied to socially situated consumer decisions like status and aesthetics. Here, we consider what motivates bottled water use in an urban city (Mashhad) in a middle-income predominantly Muslim country (Iran), where there is a likely intersection of safety (due to contamination), social norms, and status concerns. Surveys were collected with a random population-representative sample of resident adults from discrete households (n = 970). Structured equation modeling testing the relative effects on reported bottled water intentions and use shows that all these factors are shaping people's decisions. Both higher- and lower-income residents' responses suggest that status and social norms considerably influence intentions to use. Overall, even despite real safety issues with tap water, social norms and status concerns seem to weigh more heavily on residents' decisions to drink bottled water.

Characterization of Metallic Off-Flavors in Drinking Water: Health, Consumption, and Sensory Perception

Characterization of taste- and flavor-producing metals, namely iron and copper, in drinking water is a multifaceted subject. Both metals are essential nutrients, can be toxic, and are known to produce unpleasant tastes and flavor sensations in drinking water. Ingestion of trace metal contaminants through drinking water is a probable source of human exposure. Biochemical mechanisms of metallic flavor perception have been previously described; however, less is known about how variations in salivary constituents might impact individuals' sensitivities to metallic flavors and beverage consumption behaviors. This research presents findings from in vitro experiments, using artificial human saliva, to better understand the role of salivary lipids and proteins on metallic flavor production as measured by biomarkers of metal-induced oxidative stress. The results indicate that metal-induced lipid oxidation, as measured by thiobarbituric acid reactive substances (TBARS), is dominated by salivary proteins, is slightly inhibited in the presence of salivary nitrite, and is detectable by the TBARS method at and above respective concentrations of 9 µM (0.5 mg/L) and 90 µM (5 mg/L), which are both above the aesthetic standards for iron (0.3 mg/L) and copper (1.0 mg/L) in drinking water. Preliminary study with human subjects indicated that reduction in metallic flavor sensitivity, as measured by the best estimate flavor threshold for ferrous iron among 33 healthy adults aged 19-84 years old (22 females), corresponded with reduced drinking water consumption and increased caloric beverage intake among older subjects (>60 years), as determined by a validated self-reported beverage intake questionnaire. These findings provide insights for further research to examine how salivary constituents can impact humans' sensory abilities in detecting metallic off-flavors in water, and how reduced metallic flavor sensitivity may influence beverage choices and drinking water consumption.

How providing a low-cost water filter pitcher led Latino parents to reduce sugar-sweetened beverages and increase their water intake: explanatory qualitative results from the Water Up!@Home intervention trial

OBJECTIVE

This study sought to explain results of the Water Up!@Home randomized controlled trial where low-income parents were randomized to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in SSB and increases in water intake post-intervention.

DESIGN

Qualitative explanatory in-depth interviews analyzed thematically and deductively.

SETTING

Washington DC metropolitan area, US.

PARTICIPANTS

Low-income Latino parents of infants/toddlers who had participated in the Water UP! @Home randomized controlled trial.

RESULTS

The filter stimulated water consumption in both groups by: 1) increasing parents' perception of water safety, 2) acting as a cue to action to drink water, 3) improving the flavor of water (which was linked to perceptions of safety), and 4) increasing the perception that this option was more economical than purchasing bottled water. Safe and palatable drinking water was more accessible and freely available in their homes; participants felt they did not need to ration their water consumption as before. Only intervention participants were able to describe a reduction in SSB intake and described strategies, skills, and knowledge gained to reduce SSB intake. Among the comparison group, there was no thematic consensus about changes in SSB or any strategies or skills to reduce SSB intake.

CONCLUSIONS

A low-cost water filter facilitated water consumption, which actively (or passively for comparison group) displaced SSB consumption. The findings have implications for understanding and addressing the role of water security on SSB consumption.

Daily Fluid Intake Behaviors and Associated Health Effects Among Australian and United States Populations

Minimal data exist exploring intercontinental differences in fluid intake (FI) beliefs and behaviors and the impact on fluid intake practices (i.e., fluid intake volume, beverage type, and timing of fluid intake). Therefore, this study explored the impact that FI beliefs and behaviors had on FI practices among emerging adults living in the United States (USA) and Australia (AUS). A total of 489 individuals (74.5% female; USA, 79.4%; age, 25 ± 6 years completed a 23-item survey between November 2020 and June 2021). Participants detailed their FI practices. FI beliefs were evaluated to determine their contribution to FI behaviors across the day. Multinomial and multiple linear regression analyses explored the association of daily FI beliefs and behaviors across multiple domains. Independent sample t-tests and chi-square analyses were conducted to compare FI practices, beliefs, and behaviors between individuals in the USA and AUS. FI behaviors were significantly different between countries, with the USA more likely to consume fluids to meet a total target volume (β = 1.150, p = 0.036) and consume fluid at the same time as structured daily activities (β = 0.773, p = 0.046) compared to FI alongside food intake. However, there were no differences in the types of beverage consumed (juice, sugar-sweetened beverages, tea, and coffee), total fluid volume, and physical activity (PA) between countries (p &gt; 0.05). Beverage consumption was higher among USA than AUS residents for water, beer, and wine (p &lt; 0.05). Total fluid consumption was greater among males (3,189 ± 2,407 ml) than females (2,215 ± 1,132 ml; β = 3.61, p &lt; 0.001), individuals who regularly consumed fluid during the day to meet a targeted volume (β = 1,728.5, p &lt; 0.001), and those who regularly consumed fluid as a habitual behavior (β = 3.97, p &lt; 0.001) compared to those individuals who only consumed fluid alongside mealtimes (β = 1,041.7, p &lt; 0.001). FI behaviors differed between the USA and AUS; however, total volume consumed, type of beverage consumed, and FI beliefs were similar. FI practices and behaviors appear to be individualized and context-specific among the studied populations.