Skip to main content


Papers Describing Scale Development

Paper Overview

Individual Water Insecurity Experiences (IWISE)

Young, S.L., Bethancourt, H.J., Ritter, Z.R., Frongillo, E.A. (2021). The Individual Water Insecurity Experiences (IWISE) Scale: reliability, equivalence and validity of an individual-level measure of water security. BMJ Global Health.

This paper details the reliability, equivalency, and validation of the Individual Water Insecurity Experiences (IWISE) Scale. The IWISE Scale makes it possible to disaggregate experiences with water access, use, and reliability across countries at the level of the individual, such that differences by gender, age, are revealed.

Brief Individual Water Insecurity Experiences  Scale (IWISE-4)

Bethancourt H.J., Frongillo E.A., Young S.L. (2022) Validity of an abbreviated Individual Water Insecurity Experiences (IWISE-4) Scale for measuring the prevalence of water insecurity in low- and middle-income countries. Journal of Water, Sanitation & Hygiene for Development.

This paper describes the development and validation of the Brief Individual Water Insecurity Experiences (IWISE-4) Scale.

Household Water Insecurity Experiences (HWISE) Scale

Young, S.L., Godfred, B.O., Jamaluddine, Z, Miller, J.D., Frongillo, E., Neilands, T., Collins, S.M., Wutich, A., Jepson, W., Stoler, J., & HWISE Research Coordination Network. (2019). The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries. BMJ Global Health. doi: 10.1136/bmjgh-2019-001750

This is the paper describing the reliability, equivalence, and validity of the HWISE Scale.

Brief Household Water Insecurity Experiences  Scale (HWISE-4)

Young, S.L., Miller, J.D., Frongillo, E.A., Boateng, G., Jamaluddine, Z., Neilands, T., HWISE-RCN. (2021). Validity of a Four-Item Household Water Insecurity Experiences Scale for Assessing Water Issues Related to Health and Well-Being. American Journal of Tropical Medicine and Hygiene

This paper describes the development and validation of the Brief Water Insecurity Experiences (HWISE-4) Scale.
Young, S.L., Collins, S.M., Boateng, G., Neilands, T.B., Jamaluddine, Z., Miller, J.D., Brewis, A., Frongillo, E.A., Jepson, W., Melgar-Quiñonez, H., Schuster, R., Stoler, J.B., Wuitch, A., & HWISE Research Coordination Network. (2019). Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale. BMJ Open. doi: 10.1136/bmjopen-2018-023558 The protocol for HWISE Scale development.

Select Findings From Scale Application

Paper Overview

Water Insecurity and Food Insecurity

Miller, J, Young S.L., Bryan E, Ringler C. 2024. Water Insecurity Is Associated with Greater Food Insecurity and Lower Dietary Diversity: Panel Data from Sub-Saharan Africa during the COVID-19 Pandemic. Food Security. 16, 149–160.

This paper is the first evidence of water insecurity being associated with lower dietary diversity.

Young, S.L., H.J. Bethancourt, C. Cafiero, P. Gaitán-Rossi, S. Koo-Oshima, R. McDonnell, H. Melgar-Quiñonez, L. Neufeld, S. Oenema, R. Pérez-Escamilla, S. Viviani, E.A. Frongillo. (2023). Acknowledging, measuring and acting on the importance of water for food and nutrition. Nature Water.

This commentary argues that World Food Day on October 16 is an occasion to expand and harmonize the way we conceive, measure and track progress towards not just food security but also water security, two indivisible human rights.

Young S.L., Bethancourt H.J., Frongillo E.A., Viviani S, Cafiero C. (2023) Adults experiencing water insecurity are more likely to experience food insecurity in nationally representative samples of 25 low-and middle-income countries. Bulletin WHO.

The researchers show that individuals who are water insecure are more likely to experience moderate-to-severe food insecurity across 25 countries. 

Young S.L., Bethancourt H.J., Ritter Z.R., Frongillo E.A. (2022) Estimating national, demographic, and socioeconomic disparities in water insecurity experiences in low- and middle-income countries in 2020-2021: a cross-sectional, observational study, using nationally representative data. Lancet Planetary Health. 

This study describe how water insecurity varies by gender, income, urbanicity and other socio-demographic characteristics in samples representing half of the world’s population.

Wutich, A., Rosinger A.Y., Brewis A., Beresford M., Young S.L., Household Water Insecurity Experiences-Research Coordination Network. (2022) Water sharing is a distressing form of reciprocity: Shame, upset, anger, and conflict over water in 20 cross-cultural sites. American Anthropologist.

Using cross-cultural survey data from twenty global sites (n = 4,267), we test how household water reciprocity (giving and receiving) is associated with negative emotional and social outcomes. Participation in water sharing as both givers and receivers is consistently associated with greater odds of reporting shame, upset, and conflict over water.

Bethancourt H.J., Swanson Z.S., Nzunza R., Young S.L., Lomeiku L., Douglass M.J., et al. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya. Public Health Nutrition. 2022 Aug 9;1–11.

Here we show that for pastoralists living in a very dry part of northern Kenya, every 0.4 points higher they score on the HWISE (water insecurity) scale, they score 1 point higher on the HFIAS (food insecurity) Scale. This suggests the need to concurrently address water and food insecurity.

Mao F., Miller J.D., Young S.L., Krause S, Hannah D.M., HWISE-RCN. Inequality of household water security follows a Development Kuznets Curve. Nature Communications. 2022 Aug 8;13(1):4525.

Here we show that the inequality of household water security follows a Kuznets-like (inverted U-shaped) curve. The Kuznets curve is used in economics to describe how inequality first increases then decreases with the growth of wealth, here we apply it to water insecurity and introduce the concept of the Development Kuznets Curve.

Rosinger A.Y., Bethancourt H.J., Young S.L., Schultz A.F. (2021) The embodiment of water insecurity: Injuries and chronic stress in lowland Bolivia. Social Science & Medicine. Dec 291: 114490  The HWISE scales and the JMP drinking water ladder are implemented concurrently with measures of cortisol and water-related injuries to demonstrate how water insecurity can be embodied.
Young, S. (2021 Oct.). The measurement of water access and use is key for more effective food and nutrition policy. Food Policy. ;104:102138 This article lays out five ways in which measuring water security experiences makes food and nutrition policy more effective.
Miller J.D., Workman C.L., Panchang S.V., Sneegas G., Adams E.A., Young S.L., Thompson, A. (2021). Water Security and Nutrition: Current Knowledge and Research Opportunities. Adv Nutr This review lays out how water security creates an enabling environment for good nutrition— what we know and what we need to know.
Miller, J.D., Frongillo, E.A., Weke, E., Burger, R., Wekesa, P., Sheira, L., Mocello, R., Bukusi, E., Otieno, P., Cohen, C., Weiser, S., Young, S.L. (2021). Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya. Journal of Nutrition. In press. This paper describes how experiences of water and food insecurity in Kenya are distinct from wealth, and that together they both help to explain adverse health, including probable depression and diarrhea.
Young, S.L., Frongillo, E.A., Jamaluddine, Z., Melgar-Quiñonez, H., Pérez-Escamilla, R., Ringler, C., Rosinger, A. Y. (2021). The importance of water security for ensuring food security, good nutrition, and well-being. Advances in Nutrition *Based on symposium session at Nutrition 2020 This paper provides an overview of the relatively unexplored roles of water insecurity in nutrition.
Stoler, J., Miller, J., Brewis, A., Freeman, M., Harris, L., Jepson, W., Pearson, A. Rosinger, A., Shah, S., Staddon, C., Workman, C., Wutich, A., Young, S.L. (2021). Household Water Insecurity Will Complicate the Ongoing COVID-19 Response: Evidence from 29 Sites in 23 Low- and Middle-Income Countries. International Journal of Hygiene and Environmental Health. This paper discusses how various HWISE Scale items and HWISE Scale candidate items can shape COVID-19-related phenomena.

Venkataramanan, V., Geere, J., Thomae, B., Stoler, J., Hunter, P., Young, S.L., HWISE-RCN. (2020). In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries. BMJ Global Health

This paper investigates covariates of injury while fetching water, including the HWISE Scale.

Hannah, D., Lynch, I., Mao, F., Miller, J., Young, S.L., & Krause, S. (2020). Water and sanitation for all in a pandemic. Nature Sustainability. doi:

This paper discusses the role of hand washing in COVID-19, and discusses the HWISE handwashing item.

Staddon, C., Everard, M., Mytton, J., Octavianti, T., Powell, W., Quinn, N., Uddin, S, Young, S.L., Miller, J., Budds, J., Geere, J., Meehan, K., Charles, K., Stevenson, E., Vonk, J., & Mizniak, J. (2020). Water insecurity compounds the global coronavirus crisis. Water International. doi: 10.1080/02508060.2020.1769345

This paper discusses the role of hand washing in COVID-19, and discusses the HWISE handwashing item.
Rosinger, A., Brewis, A., Wutich, A., Jepson, W., Staddon, C., Stoler, J., Young, S.L., & HWISE RCN. (2020). Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments. Global Environmental Change This paper draws on data from the HWISE Scale development study to show how water sharing occurs the world over.
Bethancourt, H., Swanson, Z., Nzunza, R., Huanca, T., Conde, E., Kenney, W. L., Young, S.L., Ndiema, E., Braun, D., Pontzer, H., & Rosinger, A. (2020). Hydration in Relation to Water Insecurity, Heat Index, and Lactation Status in Two Small-Scale Populations in Hot-Humid and Hot-Arid Environment. American Journal of Human Biology. doi: 10.1002/ajhb.23447 The HWISE Scale is used in arid Kenya and lowland Bolivia as part of an investigation of determinants of hydration.
Boateng, G., Workman, C., Miller, J., Onono, M., Neilands, T., & Young, S.L. (2020). The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women. Social Science & Medicine. doi: 1016/j.socscimed.2020.113043 A Kenyan water security scale was administered concurrently with an experiential food security scale repeatedly, giving the first evidence that water insecurity predicts subsequent food insecurity.
Miller, J., Vonk, J., Staddon, C., & Young, S.L. (2020). Is household water insecurity a link between water governance and well-being? A multi-site analysis. Journal of Water, Sanitation & Hygiene for Development. doi: 10.2166/washdev.2020.165 We measured governance, water insecurity, and health in Zambia and DR Congo, and found that good governance was associated with less water insecurity and better health outcomes, and that water insecurity mediated this relationship.
Tesfaye, Y., Maes, K., Abesha, R., Young, S.L., Snyder, J., Gebremariam, A., & Freeman, M. (2020). How do rural Ethiopians rate the severity of water insecurity scale items? Implications for water insecurity measurement and interventions. Human Organization. doi: 17730/1938-3525.79.2.95
Schuster, R., Butler, M., Wutich, A., Miller, J., Young, S.L., & HWISE Research Coordination Network. (2020). “If there is no water, we cannot feed our children”: The far-reaching consequences of water insecurity on infant feeding practices and infant health across 16 low- and middle-income countries. American Journal of Human Biology. doi: 10.1002/ajhb.23357  This paper uses data from the HWISE Scale development study to show how water insecurity can jeopardize infant and young child feeding.
Brewis, A., Workman, C., Wutich, A., Jepson, W., Young, S.L., & HWISE Research Coordination Network. (2020). Household water insecurity is a plausible driver of food insecurity: Evidence from 27 sites in low- and middle-income countries. American Journal of Human Biology. doi: 10.1002/ajhb.23309 This paper uses data from the HWISE Scale development study to show water insecurity can shape infant feeding.
Stoler, J., Pearson, A., Staddon, C., Wutich, A., Mack, E., Brewis, A., Rosinger, A., & HWISE Research Coordination Network (2019). Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries. Science of the Total Environment. doi: 10.1016/j.scitotenv.2019.135881 This paper uses data from the HWISE Scale development study to show how the (un)affordability of water can touch on many aspects of well-being.
Brewis, A., Rosinger, A., Wutich, A., Adams, E., Cronk, L., Pearson, A., Workman, C.,Young, S.L., & HWISE Consortium. (2019). Water sharing, reciprocity, and need: A comparative study of interhousehold water transfers in sub‐Saharan Africa. Economic Anthropology. doi: 10.1002/sea2.12143 This paper uses data from the HWISE Scale development study to show how water sharing is a global phenomenon.