Skip to main content


Papers Describing Scale Development

Paper Overview
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.
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 (BWISE) 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.
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
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 *cover article 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.