Water insecurity and psychosocial distress: case study of the Detroit water shutoffs

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

BACKGROUND

Water, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.

METHODS

From 2020-2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.

RESULTS

Participants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02-1.58), sanitation (Adj RR:1.28; 95% CI: 1.07-1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15-1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12-1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27-1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01-1.89).

CONCLUSION

The lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Exploring the invisible water insecurity of water utility shutoffs in Detroit, Michigan

A lack of regular access to clean and safe water and sanitation is a persistent problem in many parts of the world. Most water insecurity studies focus on the world's less-industrialized and lower-income countries, where sanitation and water delivery infrastructure may never have existed. However, many individuals in higher-income countries experience invisible water insecurity, wherein specific households or individuals lack access to sanitation and clean water despite the relative wealth of their country. In the United States, invisible water insecurity tends to manifest as a result of homelessness, a lack of plumbing facilities, and water utility shut-offs. Using a water shut-off dataset from the Detroit Water and Sewerage Department, we investigate the relationship between a suite of demographic variables and the water shut-off rates in different neighborhoods throughout Detroit, Michigan. We find that shut-offs are more common in areas with more Black households that are more impoverished. Our findings indicate that this relationship links to structural disadvantage resulting from a legacy of racism and segregation in the city.

An Automated Toolchain for Camera-Enabled Sensing of Drinking Water Chlorine Residual

Chlorine residual concentration is an important parameter to prevent pathogen growth in drinking water. Disposable color changing test strips that measure chlorine in tap water are commercially available to the public; however, the color changes are difficult to read by eye, and the data are not captured for water service providers. Here we present an automated toolchain designed to process digital images of free chlorine residual test strips taken with mobile phone cameras. The toolchain crops the image using image processing algorithms that isolate the areas relevant for analysis and automatically white balances the image to allow for use with different phones and lighting conditions. The average red, green, and blue (RGB) color values of the image are used to predict a free chlorine concentration that is classified into three concentration tiers (<0.2 mg/L, 0.2-0.5 mg/L, or >0.5 mg/L), which can be reported to water users and recorded for utility use. The proposed approach was applied to three different phone types under three different lighting conditions using a standard background. This approach can discriminate between concentrations above and below 0.5 mg/L with an accuracy of 90% and 94% for training and testing data sets, respectively. Furthermore, it can discriminate between concentrations of <0.2 mg/L, 0.2-0.5 mg/L, or >0.5 mg/L with weighted-averaged F1 scores of 79% and 88% for training and testing data sets, respectively. This tool sets the stage for tap water consumers and water utilities to gather frequent measurements and high-resolution temporal and spatial data on drinking water quality.

Improved Decision-Making: A Sociotechnical Utility-Based Framework for Drinking Water Investment

To achieve the goals of the Safe Drinking Water Act, state and local water authorities need to make decisions about where to direct limited funding for infrastructure improvements and currently do so in the absence of adequate evaluative metrics. We developed a framework grounded in utility theory that compares trade-offs explicitly and broadens the factors considered in prioritizing resource allocations. Relevant existing indices were reviewed to identify data applicable to drinking water decision-making. A utility-theory-based decision analysis framework was developed and applied to evaluate how different objectives affect funding decisions for lead service line replacement (LSLR) programs in Pennsylvania and Michigan, United States. The decision framework incorporates drinking water quality characteristics with community and environmental quality attributes. We compare additive and multiplicative model structures, different weights, and spatial scales. Our decision framework showed that the inclusion of additional data beyond what is usually considered in LSLR decisions could change the top 10 counties or public water systems prioritized. Further, the counties or water systems in the top 10 were influenced by the model structure and weights. Prioritization changed based on which data were included, and has implications for the use of evaluative metrics beyond traditional water system data.

The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications

Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.

Using Water Intake Dietary Recall Data to Provide a Window into US Water Insecurity

BACKGROUND

In the United States, problems with the provision of safe, affordable water have resulted in an increasing number of adults who avoid their tap water, which could indicate underlying water insecurity. Dietary recalls provide critical nutritional surveillance data, yet have been underexplored as a water insecurity monitoring tool.

OBJECTIVES

This article aims to demonstrate how water intake variables from dietary recall data relate to and predict a key water insecurity proxy, that is, tap water avoidance.

METHODS

Using 2005-2018 NHANES data from 32,329 adults, I examine distributions and trends of mean intakes of total, plain (sum of tap and bottled water), tap, and bottled water, and percentage consuming no tap and exclusive bottled water. Second, I use multiple linear and logistic regressions to test how tap water avoidance relates to plain water intake and sugar-sweetened beverage (SSB) consumption. Next, I use receiver operating characteristics (ROC) curves to test the predictive accuracy of no plain water, no tap, and exclusive bottled water intake, and varying percentages of plain water consumed from tap water compared with tap water avoidance.

RESULTS

Trends indicate increasing plain water intake between 2005 and 2018, driven by increasing bottled water intake. In 2017-18, 51.4% of adults did not drink tap water on a given day, whereas 35.8% exclusively consumed bottled water. Adults who avoided their tap water consumed less tap and plain water, and significantly more bottled water and SSBs on a given day. No tap intake and categories of tap water intake produced 77% and 78% areas under the ROC curve in predicting tap water avoidance.

CONCLUSIONS

This study demonstrates that water intake variables from dietary recalls can be used to accurately predict tap water avoidance and provide a window into water insecurity. Growing reliance on bottled water could indicate increasing concerns about tap water.

Water Shutoff Moratoria Lowered COVID-19 Infection and Death Across U.S. States

INTRODUCTION

A total of 34 U.S. state governments imposed moratoria on water shutoffs between March and May 2020 to ensure equitable access to water during the COVID-19 pandemic. However, by the end of 2020, most of these moratoria had expired, and millions of people were exposed to the risk of water disconnections. This study examines the linkage between water equity and public health and provides policy recommendations for improving water access and health equity.

METHODS

Event study was used to analyze the impact of a water shutoff moratorium on COVID-19 daily infection growth rate and daily death growth rate from April 17, 2020 to December 31, 2020. The data were collected at the state level. The model controlled for mask mandates, at-risk groups (percentage Hispanic population, percentage essential workers), and percentage health insurance coverage.

RESULTS

During the study period, having a water shutoff moratorium in place significantly lowered the COVID-19 infection daily growth rate by 0.235% and significantly lowered the death growth rate by 0.135%. In addition, a comprehensive moratorium covering all water systems (public and private) significantly lowered the infection growth rate by 0.169% and significantly lowered the death growth rate by 0.228%.

CONCLUSIONS

This study raises attention to the importance of water equity and the need for government actions to create more uniform protections from water shutoffs across all states. A comprehensive approach to water equity can protect the health and safety of all communities.