Tapping into Correlates of Drinking Tap Water in the United States.
Open Access DepositedApproximately half of Americans do not drink water from the tap. Since less than 4-28% of the United States (US) population experiences a water safety violation in a given year, it is likely that many avoid tap water without having experienced a violation in their county of residence. National surveys indicate that lower tap consumption has unfavorable dietary correlates, including higher sugar sweetened beverages, which are a risk factor for weight gain and chronic diseases like diabetes and cancer. The objectives of this research are to quantify the association between water safety violations and tap water consumption, water safety violations and sugary drink consumption, and to determine whether perceptions of the water utility may be associated with the choice to drink water from the faucet. These objectives were addressed with three specific aims. In the first two aims, we linked nationally representative water safety and dietary surveillance data to: 1) examine associations between previous water safety violations in an individual’s county and self-reported tap water intake, and test race/ethnicity and income as moderators and 2) examine associations between previous water safety violations in an individual’s county and self-reported sugary beverage intake, and test tap water intake as a mediator. In the third aim, we analyzed survey data from the state of Virginia on water beliefs and preferences to 3) describe the associations between self-reported water beliefs and tap water preference. The results of this work informed us of the lack of alignment between both objective and perceived water safety and consumption of tap water among adults, which is significant, because it determined for the first time, the proportion which individuals avoid tap water (50.5%), even when they reside in a county that has never experienced water safety violations. Among children, tap water avoidance is similarly high in those unexposed to previous water safety violations (48.9%), but among the exposed, the odds of tap water avoidance were significantly higher (adjusted odds ratio: 1.35, 95% confidence interval: 1.01-1.80). Our findings from the water beliefs survey indicated that the odds of preferring tap water are considerably higher among individuals with the highest levels of the assessed water beliefs: trust in the water at their faucet, trust in the water utility company, perceived water quality, and perceived water safety. Nevertheless, there was still a gap between the proportion of the sample with positive water belief ratings (above 67%), and the proportion that prefer drinking from the tap (54%). Both our national and state level findings indicated a strong association between higher levels of education and greater tap water intake and tap water preference in all models. Other demographic covariates such as race/ethnicity and urbanicity were also influential correlates of tap water intake and preference. This research highlights the need for interventions to increase the trustworthiness of tap water, to reduce the disproportionate burden of low tap water intake on children, rural and minority health outcomes, and improve the health of all people living in the US.
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