We used national survey data from 2,526 US households to validate a four-item water provider trust scale. We then explored correlates of this scale using regression models to assess (1) whether the relationship between household water insecurity and water provider trust held after adjusting for personal demographics, health perceptions, and politics; (2) the mediating effects of antiestablishment orientations and perceived stress; and (3) whether these mediating effects vary by race and ethnicity. The water provider trust scale demonstrated a good fit and satisfied standard tests of dimensionality, reliability, and validity. Higher water insecurity was associated with lower water provider trust (beta = -0.111, SE = 0.013, P < 0.001) adjusting for covariates. Both antiestablishment orientations and perceived stress, when specified as mediators, yielded negative indirect effects on water provider trust and negative direct effects of water insecurity on water provider trust. These effects from antiestablishment orientations were only significant among White respondents, while the effects from perceived stress were significant across racial and ethnic groups. The water provider trust scale can help utilities assess public perceptions of their services and improve public engagement in water system resilience-building, particularly in underserved communities.

Despite a wealth of COVID-19 vaccine hesitancy research, few researchers have measured post-COVID-19 vaccine regret or its associations with other health-related attitudes and behaviors. To measure participants’ COVID-19 vaccination status, the prevalence of post-vaccination regret, and associated health-related attitudes and intentions. Online national survey in April (n = 2,036) and an online national longitudinal survey in June–July 2024 (n = 1,454). US adults aged 18 and older. The primary outcome is a three-item measure of COVID-19 vaccine regret. Approximately 15

This study used survey data collected from 5,332 households across 22 sites in 19 low- and middle-income countries to assess whether three experiential domains of water insecurity - water worry, insufficient water for personal hygiene, and interpersonal water conflict - were associated with residential mobility ideation (RMI), i.e. considering relocating the household due to water problems. In hierarchical logistic regression models, all three water insecurity domains were associated with RMI after adjusting for household characteristics related to mobility and migration. These relationships warrant further study to understand whether water interventions can mitigate displacement and other migration pressures related to global environmental change.

Recent work theorizes that the American mass opinion space is organized along two broad, uncorrelated dimensions––a left–right one and an “anti-establishment” one––that jointly explain recent events in American politics, such as the election of Donald Trump and belief in conspiracy theories. In this paper, we test several previously untested predictions of this theory, including those involving temporal dynamics. Utilizing a time series of cross-sectional surveys spanning 2019–2024 and a 2024 three-wave panel survey, we offer five findings: (i) the two dimensions remain empirically distinct; (ii) the initially orthogonal left–right and anti-establishment dimensions become moderately correlated by 2024; (iii) by 2024, this change is driven primarily by movement of the left–right dimension towards the anti-establishment one; (iv) anti-establishment sentiments are associated with two-party vote choice and presidential primary candidate preferences; and (v) anti-establishment orientations are associated with preferences for reducing government spending on science, public health, and foreign aid.

BACKGROUND:New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. METHODS:We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. DISCUSSION:We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities. REGISTRATION:osf.io/zvqs4.

Water system centralization and decentralization have variously been promoted as key to achieving household water security and Sustainable Development Goal 6.1. We argue that the lack of specificity with which scholars and practitioners use the terms centralization and decentralization limits our understanding of different water system configurations and their impacts. In this Primer, we provide a framework for thinking about levels of (de)centralization across three linked system dimensions: infrastructure, governance, and operations and maintenance. We encourage those analyzing water systems to characterize (de)centralization with respect to these multiple dimensions, as well as the system's broader political-economic and hydro-climatic contexts. Emphasizing the importance of delineating the scale of analysis, we highlight distinct system configurations and the prevalence of hybridity. Increased specificity about dimensions and scale can clarify how the character of, or changes to, a given system impact users, which is critical to assessing their implications for water security, sustainability, and equity. We conclude with recommendations for future research to analyze the opportunities and challenges associated with different water system configurations. This article is categorized under: Human Water > Water Governance.

This report conceptualizes hazard gentrification, a distinct form of gentrification that occurs when a natural hazard destroys a significant proportion of a community, and its inhabitants become displaced by wealthier residents. We differentiate this phenomenon of disaster capitalism from other forms of climate, environmental, green, and resilience gentrification; summarize its structural drivers; and review trade-offs for municipalities, environmental sustainability, and housing equity. We conclude with implications for municipal governments, who increasingly face post-disaster decision-making during the rebuilding process.

Brewis, Workman et al. (2020) provided a basis for significant subsequent advancement in understanding the interplay between household water insecurity and food insecurity across diverse global contexts. This commentary reflects on the subsequent evolution of research and its application in the 5 years since the study's initial online publication in AJHB, highlighting dynamic mechanisms that link water insecurity and food insecurity and the implications for human health. Newer studies suggest that water insecurity may drive food insecurity more significantly than vice versa, with localized case studies revealing the diversity and complexity of multi-scalar factors that contribute to these relationships. Future research priorities include more refined water insecurity measurement tools and further testing of potential mechanisms in theorized causal pathways linking water insecurity and food insecurity to each other and health outcomes.

Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (β = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (β = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.

Climate change is triggering environmental mobility through chronic water problems and punctuated events. Thinking about moving locations, or “mobility ideation”, is the precursor to migration intentionality and actual migration. Drawing on the embodiment construct, this study examines how the worst drought in recent history in the Horn of Africa affected water-related mobility ideation and, in turn, fingernail cortisol concentration (FCC), a chronic stress biomarker, among Daasanach semi-nomadic pastoralists in northern Kenya. To address these questions, we primarily draw on survey, anthropometric, water quality, and biomarker data among 175 adults living in seven communities in 2022. We used mixed-effects ordered logistic regression to test how livestock wealth, water insecurity, food insecurity, and anxiety/depression symptom scores were associated with household mobility ideation. We then used generalized linear models to test the association between mobility ideation on FCC. Thinking about moving at least once due to water problems increased from pre-drought in 2019 (55%) to during the drought in 2022 (92%), while actual mobility declined. Livestock wealth, while associated with actual mobility in the prior year, was protective against increased mobility ideation, while water insecurity, food insecurity, and anxiety/depression symptoms were associated with greater odds of thinking of leaving in 2022. Compared to adults who did not consider moving, those who considered moving rarely, sometimes, and often had FCC levels 18.1% higher (95% CI, 1.01-1.38; p=0.039), 19.4% higher (1.01-1.41; p=0.040), and 32.3% higher (1.01-1.73; p=0.039), respectively, with results consistent in sensitivity analyses. Extreme climatic events in water scarce regions may increase mobility ideation through worsened experiential indicators of well-being and resource insecurity. Mobility ideation may capture measures of adversity suffered by pastoralists and signify climate distress. This research broadens understanding of how droughts get under the skin by leading to resource insecurity and triggering thoughts of moving, which increases chronic stress.

Previous studies on disparities in triple-negative breast cancer (TNBC) focus on race/ethnicity, with few exploring the impact of contextual factors such as neighborhood-level income. This study evaluates the effect of neighborhood-level income on disparities in TNBC among a racially and ethnically diverse cohort, after accounting for granular individual-level risk factors of TNBC. Patients with stage I–IV breast cancer from 2005 to 2017 were identified from our local tumor registry. The primary outcome was diagnosis of TNBC. Using 5-years estimates from the American Community Survey, we obtained median household income for each census tract which was categorized into quartiles. Mixed effects logistic regression was conducted and stratified by race and ethnicity, controlling for individual-level sociodemographic, comorbidities, and tumor characteristics. Among 5377 breast cancer registry patients, 16.5

Social scientists, journalists, and policymakers are increasingly interested in methods to mitigate or reverse the public’s beliefs in conspiracy theories, particularly those associated with negative social consequences, including violence. We contribute to this field of research using an artificial intelligence (AI) intervention that prompts individuals to reflect on the uncertainties in their conspiracy theory beliefs. Conspiracy theory believers who interacted with our “street epistemologist” chatbot subsequently showed weaker conviction in their conspiracy theory beliefs; this was also the case for subjects who were asked to reflect on their beliefs without conversing with an AI chatbot. We found that encouraging believers to reflect on their uncertainties can weaken beliefs and that AI-powered interventions can help reduce epistemically unwarranted beliefs for some believers.

BACKGROUND:Geospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury. METHODS:We used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses. RESULTS:689 patients (58% male, median age 2 [1-8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1-6] vs. 8 [4-12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas. CONCLUSIONS:A disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations. LEVEL OF EVIDENCE:Level III. TYPE OF STUDY:Retrospective comparative study.

Access to safe water is vital for community health, especially during disaster and recovery periods when standard solutions may be slow or politically stalled. Water sharing, an informal and self-guided coping mechanism, becomes critical during disasters when standard water infrastructure is damaged or destroyed. Drawing on diverse literature, we highlight the prevalence and importance of household water sharing in disaster contexts, emphasizing its potential benefits and trade-offs. We explain why these systems-while often invisible-are important and relevant to disaster recovery. Our review identifies five key observations and implications for disaster intervention, emphasizing the need for tailored support for economically marginalized groups and the integration of water sharing practices as a short-term coping mechanism into disaster response and recovery agendas. We advocate for further research to evaluate the long-term impacts of water sharing and inform policy and intervention strategies while recognizing that such community-level coping mechanisms alongside formal water services may effectively address water insecurity and bolster resilience in disaster-affected communities.

BackgroundHandpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. ObjectiveThe aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. MethodsFrom a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization–defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households’ handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. ResultsReported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. ConclusionsOnly pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts.

Rare diseases affect 6%-8% of the population and present diagnostic challenges, particularly for historically marginalized ethnic and racial groups. The Undiagnosed Diseases Network (UDN) aims to enhance diagnosis rates and research participation among such minoritized groups. A retrospective review was conducted from 2015 to 2023, analyzing 2235 UDN participants to evaluate its progress toward this objective. Data on demographics, disease phenotypes, diagnostic outcomes, and socioeconomic factors were collected and statistical analyses assessed differences among ethnic and racial groups. This demonstrated that Hispanic and Black non-Hispanic groups were underrepresented, while White non-Hispanic participants were overrepresented in the UDN compared to the US population. Individuals whose primary language was not English were also significantly underrepresented. Diagnosis rates varied, with the highest rates among Asian non-Hispanic (39.5%) and Hispanic (35.3%) groups and the lowest rate in the White non-Hispanic group (26.8%) (p < 0.001). Binomial logistic regression found, however, that only participant age and disease phenotype predicted the likelihood of receiving a diagnosis (p < 0.001). Persistent ethnic and racial disparities in UDN participation appear to be associated with major differences in application rates. Under-enrollment of historically marginalized ethnic and racial groups may be due to economic hardships and language barriers. No differences in the diagnostic yield among ethnic and racial groups were observed after controlling for other factors. This work highlights the value of comprehensive genetic evaluations for addressing healthcare disparities and suggests priorities for advancing inclusion in rare disease research.

Progress toward achieving Sustainable Development Goal 6, clean water and sanitation for all, is behind schedule and faces substantial financial challenges. Rigorous water, sanitation, and hygiene (WASH) interventions have underperformed, casting doubt on their efficacy and potentially undermining confidence in WASH funding and investments. But these interventions have leaned on a narrow set of WASH indicators-linear growth and diarrhea-that reflect a 20th-century prioritization of microbiological water quality as the most important measurement of WASH intervention success. Even when water is microbiologically safe, hundreds of millions of people face harassment, assault, injury, poisoning, anxiety, exhaustion, depression, social exclusion, discrimination, subjugation, hunger, debt, or work, school, or family care absenteeism when retrieving or consuming household water. Measures of WASH intervention success should incorporate these impacts to reinforce the WASH value proposition. We present a way forward for implementing a monitoring and evaluation paradigm shift that can help achieve transformative WASH. This article is categorized under: Engineering Water > Water, Health, and Sanitation Human Water > Value of Water Human Water > Methods