biostudies-literatureStoler JNIEHS NIH HHSNIMH NIH HHSIMMANANational Science Foundation135881https://www.ebi.ac.uk/biostudies/studies/S-EPMC9988664biostudies-literatureUnknown716Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures The Science of the total environmentCash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries.PMC9988664R21 MH108444K01 MH098902R01 ES019841G202Young SLSchuster RCBrewis AMiller JNiesluchowski MStaddon CEscobar-Vargas JHagaman AAlexander MCarrillo GSantoso MVZinab HBoivin MTrivino NHousehold Water Insecurity Experiences (HWISE) Research Coordination NetworkMbullo PTesfaye YCole SSamayoa-Figueroa LJamaluddine ZWutich ATrowell AOmidvar NFreeman MMathad JAhmed JFMaes KJepson WTutu RAPearson ALBalogun MTshala-Katumbay DStoler JAdams ESanchez-Rodriguez ECMack ECollins SMGhattas HAsiki GSullivan AMelgar-Quinonez HRosinger AYChapman KfalseCash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries.Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures 2020-01-01T00:00:00Z2020 May2025-04-04T00:02:52.338Z2025-04-04T00:02:52.338ZS-EPMC99886643187475110.1016/j.scitotenv.2019.135881