Gendered decision making around household water use and spending is well-documented in the Global South but remains under-explored in the United States. This study examines how gender and trust in tap water influence caregivers’ use of bottled or filtered water, sugar-sweetened beverage (SSB) consumption, and attitudes toward SSB taxation in California’s San Joaquin Valley, one of the state’s most environmentally burdened regions. We analyze survey responses from 155 caregivers in Kern County, located in California’s San Joaquin Valley. We use descriptive analysis and binary logistic regression models to assess associations between gender, tap water trust, SSB consumption, and attitudes toward SSB taxation. Female caregivers are significantly more likely than male caregivers to rely on alternative water sources, despite being less likely to express concern about tap water safety, suggesting a disconnect between perception and behavior. Although male and female respondents report similar SSB consumption, females are also more likely to oppose an SSB tax, report greater price sensitivity, and are less responsive to participatory budgeting approaches. Renters are more supportive of taxation when given input on spending, while Supplemental Nutrition Assistance Program -eligible households remain skeptical. Findings suggest a disconnection between perceived water safety and actual water use and spending decisions among women, likely reflecting broader caregiving burdens and resource constraints, and point toward gendered responses to health policy interventions. Integrating gender and care work into analyses of environmental health disparities and policy design is essential for addressing water insecurity and promoting equitable health outcomes in under-resourced communities.

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