The role of water insecurity in influencing water and sugar-sweetened beverage choices: A scoping review

Water is a critical nutrient for human health, however more than 4 billion people globally lack access to safe drinking water and climate change is expected to worsen water insecurity. Simultaneously, consumption of packaged water and sugar-sweetened beverages (SSBs) is increasing globally. Despite many plausible linkages, little is known about the relationship between water insecurity and sugar-sweetened or packaged beverage selection. The current study aimed to characterize the relationship between water insecurity and beverage selection by conducting a scoping review to identify trends in available research on beverage selection among individuals experiencing water insecurity, and creating a conceptual model explaining this relationship. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guided the systematic search of 4 databases, which resulted in the inclusion of 82 studies from 7 geographical regions, representing both middle- and high- income countries. Key emergent themes included perceptions of non-packaged water characteristics, adaptive behaviors, and how each alter consumer selection of packaged water and SSBs. Frequently mentioned non-packaged water characteristics included perceived safety (n = 49; 60%), taste (n = 31; 38%), convenience/accessibility (n = 29; 35%), cost (n = 18; 22%), appearance/turbidity (n = 12; 15%), smell (n = 10; 12%), temperature (n = 9; 11%), and hardness (n = 5; 6%). Reported adaptive strategies included water treatment/filtering (n = 25; 30%) and water testing (n = 5; 6%). Associations between water insecurity and non-packaged water, packaged water, and SSB selection varied by country income classification and demographic characteristics. These can inform potential areas for future interventional trials aiming to increase trust in and selection of plain water as well as reduce reliance on packaged or sugar-sweetened beverages.Author summary: Water insecurity is a critical barrier for meeting nutritional needs. When people do not have sufficient access to non-packaged water (such as tap, well, or rainwater) that they deem acceptable for use, they may select alternative beverages for hydration. Alternatives include packaged beverages and sugary drinks, which can harm the environment through plastic pollution and human health through increased intake of added sugars. We searched the available research to identify factors that influence decisions about drinking non-packaged water and other beverages. Available research suggests that consumers identify water characteristics, such as perceived safety, taste, and temperature, as being critical in their decision about whether to use non-packaged water. When these characteristics were unfavorable, many consumers selected packaged water or sugary drinks instead. Typically, individuals who reported using water treatment methods or testing their water safety were more likely to use non-packaged water. These modifiable risk factors can be addressed through policy and programmatic interventions to improve trust in and use of non-packaged water as well as reduce intake of packaged water or sugary drinks.