Graduate and Postdoctoral Studies
Non UBC
Medicine, Faculty of
Population and Public Health (SPPH), School of
DSpace
BMC Public Health. 2019 Jul 01;19(1):853
University of British Columbia. Biodiversity Research Centre
University of British Columbia. Centre for Applied Ethics
The Author(s).
Byers, Kaylee A.
Cox, Susan M.
Lam, Raymond
Himsworth, Chelsea
Background: The presence of urban rats in the neighbourhood environment may negatively impact the physical and mental health of residents. Our study sought to describe the experiences with, perceptions of, and feelings towards rats and rat control efforts among a group of disadvantaged urban residents in Vancouver, Canada. Methods: Semi-structured interviews were held with 20 members of the Vancouver Area Network of Drug Users (VANDU) recruited by VANDU staff. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Results: Participants reported daily sightings of rats and close contact during encounters. Participants generally disliked encountering rats, raising issues of health and safety for themselves and the community due to the belief that rats carry disease. Fear of rats was common, and in some cases resulted in avoidance of rats. Effects of rats on participants were particularly pronounced for those living with rats in the home or for homeless participants who described impacts on sleep due to the sounds made by rats. Although rats were viewed as more problematic in their neighbourhood than elsewhere in Vancouver, participants believed there to be a lack of neighbourhood-level control initiatives that angered and disheartened participants. In combination with other community-level concerns (e.g., housing quality and availability), the presence of rats was viewed by some to align with a general disregard for the community and its residents. Conclusions: This study suggests that the presence of rats in urban centres may have several consequences on the physical and mental health of residents living in close contact with them. These effects may be exacerbated with continued contact with rats and when residents perceive a lack of initiative to control rats in their neighbourhood. As such, research and policies aimed at mitigating the health risks posed by rats should extend beyond disease-related risk and incorporate diverse health outcomes.
RESEARCH ARTICLE Open Access“They’re always there”: resident experiencesof living with rats in a disadvantaged urbanneighbourhoodKaylee A. Byers1,2,3* , Susan M. Cox4,5, Raymond Lam4 and Chelsea G. Himsworth2,4,6AbstractBackground: The presence of urban rats in the neighbourhood environment may negatively impact the physicaland mental health of residents. Our study sought to describe the experiences with, perceptions of, and feelingstowards rats and rat control efforts among a group of disadvantaged urban residents in Vancouver, Canada.Methods: Semi-structured interviews were held with 20 members of the Vancouver Area Network of Drug Users(VANDU) recruited by VANDU staff. Interviews were audio recorded, transcribed, and analyzed using thematicanalysis.Results: Participants reported daily sightings of rats and close contact during encounters. Participants generallydisliked encountering rats, raising issues of health and safety for themselves and the community due to the beliefthat rats carry disease. Fear of rats was common, and in some cases resulted in avoidance of rats. Effects of rats onparticipants were particularly pronounced for those living with rats in the home or for homeless participants whodescribed impacts on sleep due to the sounds made by rats. Although rats were viewed as more problematic intheir neighbourhood than elsewhere in Vancouver, participants believed there to be a lack of neighbourhood-levelcontrol initiatives that angered and disheartened participants. In combination with other community-level concerns(e.g., housing quality and availability), the presence of rats was viewed by some to align with a general disregardfor the community and its residents.Conclusions: This study suggests that the presence of rats in urban centres may have several consequences on thephysical and mental health of residents living in close contact with them. These effects may be exacerbated withcontinued contact with rats and when residents perceive a lack of initiative to control rats in their neighbourhood.As such, research and policies aimed at mitigating the health risks posed by rats should extend beyond disease-related risk and incorporate diverse health outcomes.Keywords: Rats, Mental health, Public health, Social justice, Qualitative researchBackgroundNeighbourhood environments are comprised of a constella-tion of features that influence the mental health of residents[1, 2]. For example, aspects of the built environment such astraffic level [3, 4], green space availability [5–7], and archi-tecture [8] have been linked to psychological distress [2].Despite the ubiquity of rats (Rattus spp.) in urban set-tings [9] their impacts on the mental health and well-being of urban residents has been understudied [10].Rats are a potentially important neighbourhood stressorin communities where aging infrastructure, high humanpopulation density, and low socioeconomic status allowfor rat populations to flourish [11–16] due to the avail-ability of harbourage and food sources [17–19].Rats may affect the health outcomes of residents througha number of pathways. First, rats can represent neighbour-hood disorder and deterioration. Prior work has demon-strated that the perception of an area as disordered or© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.* Correspondence: kaylee.byers@ubc.ca1Department of Interdisciplinary Studies, University of British Columbia,Vancouver, BC, Canada2Canadian Wildlife Health Cooperative, Animal Health Centre, Abbotsford, BC,CanadaFull list of author information is available at the end of the articleByers et al. BMC Public Health (2019) 19:853 https://doi.org/10.1186/s12889-019-7202-6decayed (e.g., graffiti, litter, broken glass, building abandon-ment, proximity to noxious land uses, and perceived vio-lence and safety) may cause distress [20–22], and has beenconnected to feelings of anger, anxiety, depression, fear,powerlessness, and poorer quality of life [22–27]. Indeed,work around rat-associated psychological health impactssupports the link between mental health outcomes and ratpresence [28, 29]. Because rats are more prevalent inunder-resourced areas [9] where mental health effects arealready particularly pronounced [8, 30], rat infestations maycontribute to issues of “environmental injustice” because ofgreater health burdens among disadvantaged populations[31]. Second, residents may view rats negatively due tohealth and safety concerns [32]. Rat presence is often syn-onymous with disease due to rats’ carriage of numerouspathogens transmissible to people [9]. Perceived rat-associated health risks may negatively impact mental healthoutcomes during or following interactions with rats. For ex-ample, residents who saw rats daily were more likely to re-port symptoms of depression [16], while rat exposure inthe home has been linked to physiological symptoms ofpoor mental health (e.g., headaches, dizziness, sweating,and upset stomach) [28]. This suggests that the negative ef-fects of rat presence may be intensified for those who regu-larly interact with rats.Third, because the roles of tenants and landlords inthe eradication of pests are often unclear [33–35], indi-viduals who view rat control as the landlord’s responsi-bility may be more likely to view rats and rat infestationsas environmental hazards (i.e., threats to health andquality of life due to human action) [36]. Because harm-ful environmental features are recognized determinantsof mental wellbeing [37] rats viewed within this contextmay contribute to negative mental health outcomes.Compounding this interaction, perceived inaction bylandlords to address tenant complaints can result in in-creased stress [29]. Together, these works suggest thatcontact with rats in the home environment may ad-versely affect the mental health of residents, and thatthese effects can be mitigated or amplified by the actionstaken by those deemed responsible (e.g., landlords, gov-ernments, or communities).To date, there has been only one study to evaluate theimpact of urban rats on psychological health [16]. Align-ing with the potential pathways through which rats mayaffect resident health, this quantitative study demon-strated that rat exposure may act both as an independ-ent stressor, and as a reminder of other community-levelstressors, contributing to and exacerbating perceptionsof neighbourhood disorder [16]. While this work hasbeen formative in our understanding of the relationshipbetween rats and psychological health, it does not ad-dress the breadth or extent of issues associated with ratsand their impact on residents.The aim of this qualitative study was to elicit descrip-tions of living with rats and to understand how these ex-periences affect the health and wellbeing of residents inVancouver’s Downtown Eastside (DTES), an area whereresidents frequently encounter rats [38]. Regarded asCanada’s most impoverished urban neighbourhood, ap-proximately one in every 18 people are homeless [39],and many residents live in low-income housing such asSingle Room Occupancy (SRO) units [40]. In addition,there is a significant population of individuals who, dueto the criminalization and law enforcement of drug use,are forced to use injection and non-injection drugs in“riskier” areas [41], potentially increasing their interac-tions with and exposure to rats [38]. In taking a qualita-tive approach, we sought to describe experiences withand perceptions of rats and rat control efforts amongDTES residents. Through closer attention to the experi-ences of disadvantaged urban residents, it is possible toobtain a more comprehensive understanding of the ef-fects of rats on health (both physical and psychological),which in turn will aid in devising appropriate initiativesto improve efforts to mitigate these impacts.MethodsThis is an exploratory descriptive study [42] using indi-vidual interviews to elicit and describe the experiencesof DTES residents with rats. Because of the close contactbetween DTES residents and rats, this area has been thesite of considerable urban research evaluating urban ratecology (e.g., [43, 44]) and health risks posed by rat-associated-zoonoses (e.g., [45–47]). The impetus for thisstudy came from discussions with DTES communitymembers while conducting field research on rat ecologyin the area from July 2016 – January 2017. The enthusi-asm with which residents shared their interactions withand feelings about rats highlighted a gap in knowledgearound the potential consequences of living in closecontact with rats.To conduct this study, we collaborated with the Van-couver Area Network of Drug Users (VANDU), aninternationally-recognized user-run organization thatserves as a trusted community institution with over2000 members [48]. Although VANDU’s mission is cen-tered around improving the lives of those individualswho use drugs, members may or may not be illicit drugusers [48]. We chose to recruit participants throughVANDU because: 1) VANDU has extensive experiencecollaborating in community-engaged research [49]; and2) because many of its members reside in Vancouver’sDTES and may have a greater exposure to rats due to is-sues of housing availability and quality in the DTES [40,49] in comparison to a population with stable housing.Team members (KB and CH) have worked with VANDUon urban rat research since 2010 and have maintainedByers et al. BMC Public Health (2019) 19:853 Page 2 of 13ongoing communication with the Board of Directors todisseminate findings to its members. Prior to beginningthe study, we met with the president of VANDU andone board-appointed member to discuss the study andseek permission to hold interviews on the premises. Apilot interview was performed with a member of VANDUto assess and inform the accessibility and appropriatenessof the language and content of interview questions.In August 2017 we held face to face interviews with 20individuals recruited by VANDU staff. All participants inthis convenience sample were members of VANDU andrecruited on VANDU premises. Information about thestudy was provided to recruiters and made available toparticipants prior to the interview. Inclusion criteria wascurrent residency in the DTES and English proficiency.Interviews were conducted in a private office at VANDUby KB and LR. Participants provided written informedconsent prior to interviews and received a $10 CADhonorarium. At the start of the interview, participantswere assigned a pseudonym for anonymity and wereasked for their age and years of residence in the DTES.A semi-structured interview guide (Additional file 1)was used to promote discussion around participants’ ex-periences with rats. Some questions were predetermined(e.g.., we asked participants to describe the frequencywith which they encountered rats) while others devel-oped during interviews to explore new ideas as theyarose with each participant (e.g.., in instances where par-ticipants mentioned avoiding rats, we asked participantsto describe these aversion techniques). Interviews wereaudio recorded and lasted approximately 25 min. Fieldnotes were kept by the interviewer (KB) to reflect on in-terviews following their completion.The aims of this exploratory study were to elicit and de-scribe the experiences of DTES residents with rats, and notto build a theory to explain these experiences. Theory-building requires a grounding of good descriptive work inorder to identify and saturate the categories relevant to thetheory with data [42]. Thus, we followed the descriptivequalitative content approach outlined by Sandelowski [42].The lead researcher (KB) transcribed interviews verbatim,and transcription accuracy was assessed by LR. All tran-scriptions were read by KB to conceptualize emergingthemes relevant to the overarching objective. Analysis wasundertaken using a “thematic framework” [50]. A prelimin-ary coding framework was developed by KB and SC forthematic analysis of transcripts. Some a priori codes werederived from the pre-determined interview questions (e.g..,timing and locations of rat encounters), and others wereidentified in vivo by reading through a subset of three inter-views as well as field notes (e.g., activities of participantsduring encounters). Codes were adopted according to theirrelevance to the research aims and participants’ emphasisand tendency to discuss certain topics. Interviews werecoded manually, and the thematic framework was revisedas the analysis proceeded. Themes were developed in twoways: a priori based on the interview guide (e.g., the maintheme of “Rat Encounters” was predetermined as describ-ing these experiences was a central aim of the study); andin vivo by identifying recurring ideas relevant to the re-search question (e.g., one subtheme that emerged was“People Affected by Rat Encounters” as participants oftenmentioned that they believed certain individuals to be par-ticularly affected by rats). Codes were grouped into mainthemes and subthemes that were summarized in conceptmaps reflecting the content of each interview; maps werethen compared to derive a composite map inclusive of allthemes and subthemes. Preliminary findings were pre-sented to VANDU’s Board of Directors for member check-ing of the interpretation of the findings. The Boardenthusiastically supported the results, and there were nomodifications to the themes and subthemes presented.ResultsSample characteristicsWe interviewed 20 participants (five females and fifteenmales). The median age of participants was 52.5 years (range:39–69) and the median length of residency in the DTES was12.5 years (range: 2–53). One participant identified as home-less, and one participant had been homeless previously. Tenparticipants explicitly mentioned living with rats, either intheir home at the time of the interview (n= 1), in their homein the past (n= 7), or while homeless (n= 2). Throughout theresults, participants are identified by gender (M for male, andF for female). Participants who identified as homeless whendiscussing their experiences with rats are indicated with H.The results are presented according to three themes:Rat Encounters: Context and Symbolism; Emotional andPhysical Responses; and Power, Control, and Responsi-bility. Figure 1 demonstrates a visual representation ofthe thematic structure.Rat encounters: context and symbolism“Every day I go out I see a rat, it’s a guarantee.”Most participants reported encountering rats daily oralmost daily and described seeing anywhere from two to“hundreds” of rats regularly. Sightings were routinely inthe early morning or at night, although participants wereadamant that rats could be encountered at all hours.Some vigorously described the heightened sense of ratpresence or abundance as troublesome.“If you could count every goddamn rat that goes bythere’re probably more fuckin’ rats around thanpeople around the streets.” – Owen (M)Vancouver was thought to have more rats than otherCanadian cities where participants had lived (e.g.,Byers et al. BMC Public Health (2019) 19:853 Page 3 of 13Winnipeg and Edmonton). This was attributed to anabundance of resources available to rats, specifically accessto food from markets and food waste from restaurants.The warmer climate was also thought to be more hospit-able to rats than other colder Canadian cities. Several par-ticipants believed that rat encounters were more frequentthan approximately five to ten years prior. Participants at-tributed this increase to rats’ rapid reproductive rate andsubsequent population growth. Only one participant be-lieved there to be fewer rats than in the past.“They multiply like crazy. That’s why there needs tobe a handle on them. There needs to be a populationcontrol. Umm, otherwise they’ll run us over and outof town. Well, it could happen.” – Ernest (M)Rats were considered to be “part of the DTES” due to theirconstant presence and prevalence. The ubiquity of rats wasemphasized by almost half of participants and was particu-larly felt among women who stated that rats could be en-countered “everywhere” in the DTES. For some, theysymbolized “bad human rights”; for others, they were associ-ated with issues of personal safety and neighbourhood dis-order. Indeed, one participant indicated that the more oftenthey saw rats, the “more dirty” they considered the city to be.“Everything that’s in a horror movie is down here. It’sjust so weird, you know? And rats – it’s interesting.They just fit right in.” – Noreen (F)Sightings occurred in alleys, public parks, and buildings,with participants recounting stories of rats in their resi-dence or in the residence of friends. Encounters also oc-curred at a local community garden and soup kitchenwhere participants had volunteered. However, interactionswere most common in alleys, near to dumpsters, with oneparticipant stating that rats could be seen near every dump-ster in an alley. In part, it was this proximity to refuse thatled participants to associate rats with garbage and being“dirty”, although this perception was also attributed to theirappearance, and the smell associated with their presence.“They’re dirty little creatures... Uhh well, they get inthe garbage and everything eh? So, I don’t really carefor critters like that.” – Hugh (M)Encounters commonly occurred while walking in al-leys, and some came into contact with rats while drink-ing alcohol or using drugs. While participants did notrecount personal experiences of injecting drugs in thepresence of rats, one participant felt that encounteringrats was “probably a regular thing for injection users”.“It just depends when I go hang around and go with mybuddies, smoke up ‘n that, walk around with them,that’s the only time I guess I see the rats.” – Owen (M)The most striking and recurring description of rat en-counters was the proximity of rats to people and theFig. 1 Thematic structure detailing the experiences of residents living with rats. The chief areas of description and analysis are summarized withineach of the three themes: Rat Encounters: Context and Symbolism; Emotional and Physical Responses; and Power, Control, and Responsibility. Ratby Jake Dunham, available through the Noun ProjectByers et al. BMC Public Health (2019) 19:853 Page 4 of 13lack of “personal boundaries”. Participants perceived ratsto be “bold” and/or not “afraid of humans”, and this ten-dency to approach residents was viewed as bothersomeand elicited fear in some participants. Other participantsshared stories about encounters with rats that were vividin detail and almost humorous in their characterizationsof how the rats interacted with humans.“I had one I was sitting on (street), there was a bag ofbagels, and these bagels were like, multigrain, stale[pause] heavy, heavy things and it come out of thishole right beside me, like two inches from my body, Irecognized that it was there immediately, the presenceof it was so massive, and I glanced down… Hecrawled into this bag of bagels and with these freakin’teeth that musta been huge, he chomped down ontothis bagel, picked it up, backed out of this bag ofbagels, turned around and went back in the wall. Thewhole time rubbing against my thigh, without an issue– without an issue. They’re just nuts.” – Ima (M, H)The uneasiness ascribed to the proximity of rats wasoften linked to the belief that “bacteria” or “parasites”could be transmitted from rats to people through closecontact. Despite a dearth of specific disease knowledgebased in academic terms, participants were universallyafraid of rat-associated diseases based on their perceivedseverity. Indeed, disease carriage and the risk of diseasetransmission to people was mentioned by nearly all par-ticipants. Although the majority were unsure of whichdiseases rats carried, five participants correctly citedplague and one suggested both Escherichia coli and Sal-monella spp., that have been reported in rat feces [51].Other diseases mentioned by participants, but that arenot recognized-rat associated zoonoses, were rabies,malaria, and scurvy [9]. Although some participants in-dicated that they could not recall the disease name, theybelieved that the illness would present with flu-likesymptoms. One participant directly linked the presenceof rats to their own poor physical health.“And they affect your breathing ‘cuz they’re shittingeverywhere ‘n it gives ya flu-like symptoms right?” –Fred (M)Rat bites were consistently cited as a route of diseasetransmission, either by infection with rat-associated path-ogens or due to the introduction of bacteria from the en-vironment into the wound. Participants also believed thatthey could contract a rat-associated illness through ascratch, contact with the rat’s fur, “droppings,” or by con-suming food contaminated with rat feces. Participantswere particularly concerned about food contamination intheir homes, and one participant who volunteered at asoup kitchen highlighted their concern for contaminationof food served to DTES residents.“It’s just a fact of like they carry diseases and, you justnever know like, one bite ‘n god knows what canhappen to you… it’s just health issues... cuz they getinto everything, they chew up everything and eventheir droppings, like you just never know like and ifyou miss one or something.” – Aubrey (F)Fear of being bitten was not just associated with dis-ease risks, but also with pain due to the strength of arat’s bite. Some participants recounted being bitten byrats, or stories of other residents being bitten. Rat biteswere often related to the tendency for rats to be ag-gressive, although one participant believed that theseaggressive behaviours were “like any animal… evenus”. In line with associations of aggression, two par-ticipants mentioned that when they thought of rats,they were reminded of the horror movies Willard andBen from the early 1970s that involve rats attackingand killing people.“A rat’s mouth – those teeth? They’re chewin’ throughbrick. So, you can imagine when they chomp on you?Wake up nothin’, you’ll be screamin’ in pain.” – Fred (M)While rats were considered a public health concern,they were largely thought to be about as important asother pests (e.g., cockroaches and bedbugs). In fact, bed-bugs were seen by some to be more concerning as theyoccupy the home and bite people. For example, one par-ticipant identified bedbugs as a concern when lookingfor housing, while none of the interviewed participantsidentified the presence of rats as a condition when rent-ing an apartment. Rats may have been seen as compar-able to other pests because most participants could notrecount an instance where someone they knew becameseriously ill from coming into contact with a rat. For ex-ample, several participants indicated that rats would gainmore community-level significance if there was an out-break of a rat-associated disease.“I think [rats are] pretty important right now, but notmore important than some of the other stuff. I thinkit’s important in terms of public health.” – Bruce (M)Interestingly, several participants mentioned that ratswere vilified or judged in a way that reflected how partici-pants themselves felt judged by the Vancouver community.“I feel like we’re being looked at like we’reoverpopulated like the rats.” “It makes me feel sad.Because, the way people look down on us, theyByers et al. BMC Public Health (2019) 19:853 Page 5 of 13discriminate us, they judge us. It’s like, me talkin’about rats right now, I feel like I’m [pause] judgingthem.” – Renee (F)Because many DTES residents have rats as pets (eitherdomesticated or wild caught) participants also associatedrats with pets. Although pet rats were described as gener-ally different from alley rats in appearance, only one par-ticipant expressed that it was “nice to see” pet rats. Whileone participant found pet rats to be “just another domesti-cated animal”, the majority of participants described un-easiness around them due to the potential that they “carrydisease” and/or because of the supposed tendency of ratsto defecate or urinate on their owners. In this way, it didnot seem to matter to participants “what kind of rat it is”,with pet rats and wild rats embodying similar threats.“Rats as, for a pet? I’m sorry. To me that is stupid. I[pause] to have a rat?... The people have them in theirshirts ‘n their jackets. The rats pee and poo on ‘em.Who wants to have a pet that pees on ‘em? Poos onem? I don’t. But these people here do. I don’t get it. Idon’t get it and I don’t want to get it.” – Ernest (M)Rats were viewed as “almost the same” as other urbanexploiter species (e.g., pigeons), pests (e.g., mice andcockroaches) and people. For some, the filth associatedwith rats and other urban animals was considered to bea result of living in the DTES and not necessarily an in-dependent characteristic of the animal. Although paral-lels were drawn between mice and rats in their ability toinfest buildings and carry disease, the mice’s appearanceand behaviors were considered “cute” and “playful”. Par-ticipants who highlighted the commonality of rats withother animals also tended to view rats as natural parts ofthe environment or as serving a purpose.“Well rats are pretty dirty, eh? Uh, but I guesseverything that lives down here is, ya’know? Eventhe birds ‘n, and the skunks and everything that’srunnin’ around… Doesn’t really bother me… I’msure there’s lots of ‘em that – that live here,ya’know? Even after we’re gone, they’ll still behere… there’s not too much we can do about it,ya’know? You can’t really kill ‘em all, I’m sure theyserve a purpose, ya’know.” – Phil (M)In contrast, because rats are “not native” to NorthAmerica, some felt that they either “don’t belong” in theDTES, or that they were responsible for the eradicationof other native species.“Instead of chipmunks, there’s rats. Or, instead ofsquirrels, there’s rats.” – Noreen (F)Participants who held this viewpoint believed that ratsshould be “absolutely eliminated”.Finally, participants emphasized commonalities be-tween the behaviors of rats and people. For example,participants told stories of rats stealing residents’ be-longings (e.g., drugs), or acquiring addictions to drugs.These stories were recounted with humour and ap-peared to be commonly shared in the community.“Actually, there was a picture of one… sucking on theend of the syringe... we made jokes about it all thetime. Heroin rats ‘n stuff.” – Claudia (F)“Have you heard other stories about heroin rats?” –Interviewer“Yea. Like... they’ll come out and take peoples stuff[heroin]...” – Claudia“Why do you think they take it?” – Interviewer“Because they’ve already tried before, right? So [pause]they know what it is and they’re taking it just likepeople would do, right?” – ClaudiaEmotional and physical responses“Maybe people with homes, they don’t have this kindof problem.”Rats were considered more important for those livingwith them, either in their residence or when they werehomeless, than for participants without rats in their home.This may be because for those without rats in their home,the distance from rats physically put them “out of sight outof mind”, whereas participants living with rats were con-tinuously reminded of their presence. For example, oneparticipant joked that when living with rats it was as thoughthey were “in [the rat’s] space now, more than he’s in mine”.The invasive and pervasive nature of rats led one homelessparticipant to indicate that rats were the second most im-portant factor in their life after possession theft.“It’s exhausting. You – you never, you can never –they’re just – they’re so fuckin’ persistent they won’tleave you alone. You live on the Eastside and you liveoutside, bein’ homeless. I dunno, maybe people withhomes, they don’t have this kind of problem. But I’moutside all the time and they’re always there. They’realways there.” – Ima (M, H)On a physical level, participants living with rats de-scribed damage to their belongings, an inability to storefood, and effects on their sleep. Participants revealedthat the impact of rats at night “turns into somethin’Byers et al. BMC Public Health (2019) 19:853 Page 6 of 13different”. Specifically, some participants altered whereand when they slept to correspond with times that wererelatively “rat free”. These changes ultimately affectedthe amount and quality of sleep they achieved.“I remember gettin’ woken up and they were like, I don’tknow what they were doing, they were nibbling on myhand or, ‘cuz I was sleepin’ and somethin’ woke me up,ya’know? Whether it ran by my hand or I don’t know, but,yea, they used to really bother me in there.” – Phil (M)Impacts on sleep were attributed to the “skittering” soundsmade by rats which were considered unsettling. Participantsparticularly affected by these sounds emphasized their vol-ume, with one participant comparing the noises to “a six-footmale… moving furniture”. The rich description of the soundsmade by rats indicated a keen awareness of their presence.“The visual – somehow that’s expected, I don’t know.But the noises, you don’t know what it’s going tosound like, or, or the power that’s there in their littlefeet or something.” – Charlie (M)Sounds made by rats were also disturbing during theday. One participant vividly recounted overhearing amischief of rats:“I was over by (building name) and I could hear them.Like, in the [pause] like, tons of them running acrossumm, the garage doors on top of the garage? Oh mygod, it freaked me out, like it just freaked me out, itjust ugh [pause] scared me. I thought they were gonnacome falling out of the ceiling or something [pause] itwas horrible.” – Claudia (F)The participant later indicated that following this en-counter she couldn’t sleep at night.On a psychological level, the majority of participantswere bothered by the presence of rats. Participants de-scribed encounters with rats as alarming, unsettling, an-gering, exhausting, worrisome or eliciting fear. Thesefeelings were particularly pronounced for participantswhere rat encounters were “reoccurring”, and the contin-ued alarm from confronting rats raised concerns of beingbitten. In some instances, this constant exposure to ratsresulted in increased sensitization to their presence suchthat any contact with rats elicited an immediate negativeresponse. Indeed, the perceived consequences of livingwith rats went beyond direct interactions (i.e., rat bites) asdescribed by one participant who articulated a potentialcascade of negative effects from a rat infestation.“Just how to get, how to get rid of them. What I coulddo to get them out of the house. Yea um [pause] andworry about is, are the walls going to start to smell, is it,you know, is this place gonna be all disgusting? If mycat gets a hold of one and eats one, will I have a sick caton my hand? Will I get sick from touching my cat if sheeats a rat? Those kind of thoughts.” – Charlie (M)Fear was the principal feeling associated with ratsand was evidenced in the characteristics attributedto them (e.g., disease and biting) and in the storiestold by participants.“I think about horror movie type things like… you’veinjured yourself and can’t move, and then rats willstart eating you... I’ve heard of things like thathappening down here.” – Noreen (F)Fear was particularly acute among women. All femaleparticipants described fear of rats, and men indicatedthat their female friends or partners were also afraid.One male participant specifically mentioned their femalefriends becoming “unsure, nervous, and uncomfortable”in alleys where they had encountered rats before. Onefemale participant who was particularly afraid of ratsemphasized her inability to be alone and required thather partner carry her to the tent where they were livingfor fear of being touched.“Every night I had – my boyfriend would have to carryme up the hill, because of the rats, right? I – ‘cuz Ididn’t want them to touch me or anything right? I wasliving in a tent… I was… never alone, right? I wouldn’tsit by the door. Yea, I don’t know. I don’t know why I’mso scared of them.” – Joanne (F, H)Anger was the second most cited emotional responseto the presence of rats due to the observed impact ofrats on other community members and because of theperceived inaction of responsible bodies to control rats.“It makes me mad only that I know the reason thatthe rat’s usually around is that somebody’s not doingthe right thing” – Mike (M)In response to these negative feelings, purposefullyavoiding rats was common among participants, but con-sidered difficult due to their ubiquity. For some, itseemed that the only way to avoid rats was to “get out of[the] neighbourhood”. When outdoors, participants de-scribed “keep[ing their] distance” from rats by avoidingheavily infested areas or choosing to sit in areas in alleyswhere they were less likely to be approached by rats.Some participants described more purposeful avoidanceof rats. For example, one participant mentioned that ratsprevented them from participating in social activitiesByers et al. BMC Public Health (2019) 19:853 Page 7 of 13that they enjoyed, including volunteering at a commu-nity garden and walking in alleys in the evening.“Even when we were umm, doin’ the garden, therewas rats. And I used to love working in the gardenlike, volunteering, but now I won’t go because of therats.” – Renee (F)Another participant vividly described the precau-tions they took to prevent contact with rats whilesleeping. These precautions included hanging food, a“proximity alarm” to alert them of the presence ofrats, and efforts to “cocoon” themselves inside oftheir blankets while sleeping, with only “a little venthole for their mouths.”“I had a bag of chips beside me, but I put it thereintentionally because when they touch that… it makesa noise and it wakes me up and it’s like a proximityalarm right? I know they’re gettin’ close so I can, I getup and I’ll scare ‘em away... And I heard that noise.And I glanced over... And this huge cat-like creaturejumped up because I scared the shit out of it, and itjumped straight up and landed on my face, then hejumped up again and he landed right back on my facethen he ran down my chest, underneath the blankets,all along my thigh, and out the – out the foot of theblankets.” – Ima (M, H)Whether bothered or not by the presence of rats, mostparticipants believed that they had become “just the norm”.“Well, you see them all the time, right? So basicallythey’re a main part of your life, right? Like, they’reeverywhere. So you see them at least every hour, if notless than that, unless you leave this area. Which Idon’t do a lot of... Yea they’re in my life all day longso [pause] and it’s not like you get used to it, ‘cuzyou can’t get used to that, you kinda do but youdon’t right? Like, it’s – nothing surprises youright?” – Claudia (F)Some viewed this acclimatization to rats as necessaryto cope with them because thinking of rats wouldheighten their anxiety, while others believed this ap-proach to dealing with rats to be unnatural.“People are so used to it already ‘cuz it’s gone so long,they don’t even – you don’t even hear anybody yellanymore. Before you used to hear a squeal, fuck!Seven years ago you used to hear girls every once in awhile in the alley “Eeee!” You don’t even hear thatanymore ‘cuz they’re so used to ‘em running aroundwhich is – that’s pathetic!” – Fred (M)Power, control, and responsibility“It’s not the rats that’re wrong, it’s the landlord that’swrong.”Rat control was mostly thought to be the responsibility ofthe city, building managers, and residents, although one par-ticipant mentioned the importance of involving port officialsdue to the potential for rats to enter the DTES via ships.“The city. Umm [pause] homeowners too if they havethem in their back lane and they put their garbage out andthey know they have rats. Anybody that’s got a rat problemshould be responsible. Not just the city.” – Ernest (M)The desire for city-initiated trapping and poisoningprograms to eradicate rats was mentioned by most par-ticipants, although three participants preferred less“cruel” methods of control. Other necessary control ac-tions were thought to be the establishment and trainingof a specialized “crew” of people to deal with rat infesta-tions. Although one participant indicated that VANDUserves as a source of information on rats for communitymembers (through their collaboration with the Vancou-ver Rat Project), participants underscored the import-ance of educating residents about rats, the diseases theycarry, and how to control them.“Like a pamphlet. I don’t see any kind of thing thatsay uhh ‘we have that problem down here and peopleneed to be aware of it and this is how you deal withit.’” – Ian (M)Improved cleanliness and the need for residents to tidytheir own environments was stressed to reduce resourceavailability to rats. However, many did not believe that thisapproach would be adopted by everyone, particularly bythose whose activities involved sorting through refuse forbottles or valuables. Additional methods of control men-tioned were birth control and the introduction of predators.Well I mean if people would clean up, like, clean upafter themselves... I don’t think you would see thatmany eh? Yea. Like in the last few years, I startedseeing a bit more of them because people leave theirgarbage behind, right? – Hugh (M)Few participants recognized visible control initiativesin the DTES, citing poison bait boxes and metal cagetraps in the alleys. It is worth mentioning that thesemetal traps were not part of a control effort, but insteadpart of the Vancouver Rat Project’s research. Indeed, fourparticipants mentioned that they thought these trapswere part of a study. Participants noted some ongoingefforts to clean the alleys and remove garbage that wereByers et al. BMC Public Health (2019) 19:853 Page 8 of 13thought to minimize the presence of rats. Regardless,participants felt that control efforts were insufficient.“For one thing, they could clean up the alleys ‘n stuffmore, but I know they try. See I’m making it sound likethey’re not, and I know better. They try – I see it ‘n youhear the trucks all the time, but they just – they don’thave the manpower to keep up.” – Fred (M)The majority of participants felt that there was little orno evidence of control efforts being enacted in the city.This perceived inaction was attributed to both the seem-ingly large population of rats and the absence of any ob-served control methods. Because of this, someparticipants revealed that they were unaware of whothey could report rat infestations to.“Who would you go to? Why wouldn’t you just dealwith it yourself? [pause] I dunno, there’s not reallyanywhere to go is there? I dunno. I don’t think so... Iassumed it was our own problem to deal with becausenobody dealt with it before.” – Claudia (F)Moreover, some participants emphasized that even if re-ports of rats were made to building managers, that these re-ports were unlikely to receive any immediate action,underscoring the perceived futility of reporting rat infestationsto building managers or landlords. This contributed to feel-ings that dealing with rats was the tenants’ own responsibility.“I don’t know how quick they would act on it... like inthese SROs? They don’t do nothin’. ‘Cuz I’ve lived in‘em, I lived in (location) there in – they used to runfrom room to room at night, ya’know? Yea, big holes,ya’know? Just goin’ room to room.” – Phil (M)In three instances, impacts from rat infestations culmi-nated in participants moving out of their residence.However, many implied that avoiding rats by movingwas impossible due to limited availability of housing.“Well downtown here you don’t really ask you justgotta settle with what you can get as long as you got abed, a roof over your head it’s [pause] you just gottatake it.” – Aubrey (F)This connection between the availability of housingand the presence of rats revealed feelings of powerless-ness, hopelessness, and anger among participants whofelt “stuck” in the DTES.“Your hands are tied ‘cuz where’re you gonna live forone thing? [pause] You’re stuck here anyways in thisshit, right?” – Fred (M)Overwhelmingly, participants indicated a lack of af-fordable housing as the chief issue facing the commu-nity. Indeed, a number of participants emphasized theirdisgust with city officials for what they perceived to be“zero” action around addressing homelessness in theDTES. Further, the housing available to residents wasviewed as being of poor quality. In contrast to the im-portance of housing, prioritizing rat control wasviewed as “silly”.“There’s so much else to deal with, like c’mon. Let’sdeal with homelessness before we deal with the ratsituation, seriously. Honestly, like putting money intosomething like that is just silly over homelessness,right?” – Claudia (F)The intersection between a lack of action in control-ling rats, and the paucity of housing were attributed to ageneral disregard for the DTES and its residents by thecity. Participants articulated feelings that their commu-nity was being neglected, and that DTES residents “don’tcount” due to homelessness or drug use. Indeed, a fewparticipants perceived this inaction to be purposeful, andthat the government was “targeting” them in order tomake the land available for wealthier residents. By com-parison, participants believed that similar infestationselsewhere in Vancouver would receive immediate action.When discussing this issue, many participants cited feel-ings of anger, while others listed hurt, sadness, depres-sion, confusion and marginalization.“I don’t think they think it’s that important... Wellbecause it’s DTES right? So they really don’t care aboutthe people down here. Because if they did they wouldhave more housing for people, right?” – Hugh (M)Although participants identified a need for control andwere clear about who they believed to be responsible,many thought that the problem “couldn’t be fixed” dueto rats’ prevalence, abundance, rapid reproductive rate,and their continuous potential to arrive to Vancouver onships via the international shipping port. Moreover, theurgency to control rats was overshadowed by other im-portant issues facing the DTES community such as the“fentanyl crisis,” and police harassment. When speakingof the fentanyl crisis, participants were concerned aboutthe “safety surrounding people’s lives” and emphasizedthat “a lot of friends [were] gone” due to overdosedeaths. One participant implied that these losses werechanging the close-knit dynamics of the community. Interms of police harassment, one participant viewed po-lice inquiry as excessive, such that residents would get“jacked up, pulled over, for standing around”, emphasiz-ing that they felt the need to keep moving to avoidByers et al. BMC Public Health (2019) 19:853 Page 9 of 13police attention. For these participants, these issues wereongoing and disruptive, whereas rats were viewed asmore of a nuisance than a serious concern.DiscussionOur research describes the experiences of disadvantagedresidents living with rats and reveals that the impacts ofrats extend beyond disease-related risks. We demonstratethat chronic rat exposure may influence both the mentaland physical health of residents. Notably, rats cause dis-tress and uneasiness among those living with them, andnegatively impact the sleep of residents, causing them totake precautionary measures to decrease their interactionswith rats. Further, due to the symbolism surrounding rats,they contribute to views of a neighbourhood as disor-dered, promoting feelings of social neglect and disregard.The effects of rats arise not only due to their presence, butalso from a perceived lack of action to control rats by thegroups deemed responsible.This study reveals that the public health threats posedby rats extend beyond those associated with the trans-mission of infectious diseases. Specifically, rats and rat-related issues can contribute to negative impacts on themental health of residents. We document that exposureto rats was associated with feelings of anxiety, fear, andworry. In line with a quantitative study performed byGerman and Latkin, we found that negative perceptionsof rats were not restricted to those who see rats regularly[16]. However, psychological impacts were amplified forthose with daily rat exposure, especially among thosewho live in close contact with rats. For participants liv-ing with rats, we found that the effects were greatest atnight, when rats, and the noises associated with them,disrupted participants’ sleep. The relationship betweensleep disturbance and poor mental health has been dis-cussed previously [52–54] and studies suggest thatstressors have a greater impact on individuals who havepoorer sleep quality [55, 56]. Thus, the effects of rats onsleep quality could exacerbate their impacts on the psy-chological distress of individuals already vulnerable torats, as well as sensitize them to other environmentalhazards in their community.Rats can serve as a chronic and uncontrollable stressorfor residents with frequent exposure to them. In contrastto “acute” stressors, that occur over discrete time pe-riods (e.g., an argument with a family member),“chronic” stressors are frequent and ongoing (e.g., long-term problems with children) [57–59]. Participants inthis study described everyday interactions with rats,whether while outdoors, visiting friends, or at home.Therefore, specific interactions with rats may serve asacute stressors, while continuous exposure to rats mayrepresent a chronic stressor. This is concerning becausechronic stressors may negatively affect mental healthoutcomes (e.g., psychological distress and depression) asmuch, if not more so, than acute stressors because theyrepresent unresolved problems [58, 60]. Such unavoid-able issues can promote feelings of hopelessness [61], ev-idenced in the ways in which participants described theirinability to avoid rats without leaving their neighbour-hood. Indeed, rat presence was so ubiquitous that someparticipants recalled seeing hundreds of rats in a singleday. The pervasiveness of rats in the environment un-derscores issues of environmental injustice, whereby res-idents of under-resourced settings are disproportionatelyaffected by stressors such as rats in comparison to moreaffluent communities.To mitigate the negative effects of rats, participantsemployed a number of coping mechanisms. Althoughseveral participants expressed a passive acceptance ofrats as part of the environment, there was no clear evi-dence of desensitization (i.e., that repeated rat exposuredecreased their negative psychological impact). Instead,participants described a heightened awareness of rats,wherein they actively employed avoidance techniques,such as sitting in places where they were less likely to beapproached by rats, spending time in alleys known tohave relatively fewer rats, or employing measures to pre-vent contact with rats while sleeping. In some instances,avoidance was more pronounced. For example, the pres-ence of rats prevented participants from enjoying com-munity activities (e.g., volunteering at a local garden).While avoidance allows individuals to reduce their stressby removing the stressor from their daily experience[62], barriers to residents’ abilities to engage in social ac-tivities can potentially strengthen the effect of rats onhealth. This is because engaging in community-level ac-tivities can provide opportunities for social support, thatin turn buffers the negative effects of stressors on mental[59, 63] and physical health outcomes [64].Beyond the direct links between rats and the health ofresidents, rats represent larger community-level issues.This may be due, in part, to the stigma around rats them-selves. Almost universally, participants in this study de-scribed rats as filthy and diseased, likening them tocharacters from horror movies. Previous work has demon-strated that the symbolism embodied by certain neigh-bourhood elements can signify other, more complexcommunity-level issues. For example, Derges et al. foundthat the disgust associated with the presence of dog feceshints at a greater dissatisfaction with a spectrum of issuesincluding litter, drug use, crime, and feelings ofmarginalization [65]. Indeed, some residents in our studylikened their dislike of rats as being similar to their feel-ings of being stigmatized and marginalized by the greaterVancouver community. In this way, the symbolic presenceof rats can contribute to and/or reflect feelings of socialneglect. Similarly, rats may also denote issues of socialByers et al. BMC Public Health (2019) 19:853 Page 10 of 13injustice and contribute to the perception of a neighbour-hood as inferior or decayed. In line with participants’ de-scriptions of rats as dirty, they also described theirneighbourhood as filthy and neglected. In fact, many resi-dents implied that rats were more abundant in the DTESthan elsewhere in the city because of poor neighbourhoodsanitation. These negative perceptions of the neighbour-hood environment can also contribute to poor mentalhealth outcomes [66]. For example, poor mental well-being, such as feelings of depression and hopelessness, hasbeen linked to indices of community disorder (e.g., litter,broken glass, building abandonment etc.) [67]. As such,rats may have both a direct and indirect impact on themental health of residents by intensifying other commu-nity-level stressors.Mental health impacts may be compounded by theperceived inaction of responsible bodies to control them.We found that participants largely felt that rat controlwas the responsibility of landlords and the city, but thatultimately it fell to residents to perform their own con-trol because they felt that neither the municipal govern-ment nor the landlords in the DTES prioritized ratinfestations; this sentiment was consistent with a hous-ing study performed in the same neighbourhood [68].Further, participants voiced concerns that they were un-able to control rats themselves, which may be due inpart to the limited resources available to disadvantagedresidents [69]. This view of rats as the landlord’s respon-sibility, in combination with feeling incapable of address-ing rat-associated issues personally, suggests that ratscould affect mental health as an environmental hazard[36]. Indeed, perceived inaction by those seen as respon-sible was met with feelings of anger, frustration, helpless-ness, marginalization, and sadness. These findingssupport previous research that found that municipalgovernment inaction to deal with rat infestations led tofeelings of helplessness among low-income residents[16], while landlord inaction increased stress by creatinglandlord-tenant conflicts [29]. Overall, our study re-vealed a strongly held belief that there was a lack of vis-ible interest by those in positions of power to controlrats due to a general disregard for the DTES and its resi-dents. This perception appeared to contribute to adversemental health outcomes for participants.Rats are part of a spectrum of issues facing disadvan-taged communities. Specifically, participants viewedhousing availability/affordability and drug overdoses asthe most significant community concerns. In contrast tothe urgent nature of the housing [70] and drug overdosecrises [71], rat infestations do not represent an immedi-ate threat to residents. However, it is important torecognize that rats cannot easily be disentangled fromthe broader environmental health issues afflicting thecommunity. For example, in a study interviewing femalesex workers about the challenges of finding affordablehousing in the DTES, individuals included rats as a con-tributor to deplorable and uninhabitable living condi-tions [69]. Downplaying the importance of rat issues inlight of other societal issues is problematic because itcan lead to an ineffectual response to infestations andthe consequences associated with them [72].Strengths and limitationsThis study has several limitations to be considered. First, oursampling of participants was restricted to members of acommunity-based organization, preventing us from makinggeneralizations about the experiences of all residents in theDTES, or to residents of other low-income areas. Second,due to the sampling of our study, we are unable to offerrigorous comparisons about differences in experience arisingin the data according to participant characteristics such asgender and housing status. For example, of the participantsinterviewed, five of 20 were women, while only two of 20identified as living with rats while homeless. Given thatwomen in our study emphasized feelings of fear and discom-fort around rats, and that male participants also identifiedfeelings of fear among their female partners and/or friends,further focus on how individuals experience rats in relationto gender is an important area for future research. Similarly,that participants identifying as homeless considered rats tobe more important to them than did those with homes sug-gests that future research in this area would benefit from ex-plicit and purposive sampling of homeless persons.Despite these limitations, this exploratory study is thefirst to our knowledge to qualitatively describe the expe-riences of residents with rats and strengthens the grow-ing body of literature suggesting that interactions withrats can negatively impact the mental health of residents[10]. Given this association, we suggest that future workbuild upon these findings to gather data which addressesthe underlying pathways through which rats impact thehealth outcomes of residents, as well as how these inter-actions relate to other environmental hazards experi-enced in urban settings.ConclusionsThis study supports the need to re-evaluate the ways inwhich we conceptualize the consequences of living withrats to incorporate diverse health outcomes. While thechronic nature of rat infestations in some low-incomecity settings may diminish the importance placed ontheir control, their role as an independent stressor andtheir contribution to other neighbourhood-level issuesnecessitates proactive approaches to rats. As such, inte-grated approaches engaging governments, landlords, andcommunities is necessary to monitor and mitigate theimpacts of rats in the urban environment and promoteeffective control initiatives.Byers et al. BMC Public Health (2019) 19:853 Page 11 of 13Additional fileAdditional file 1: Interview Guide. Provides a list of questions used toguide interviews with participants regarding their experiences living withrats. (DOCX 15 kb)AbbreviationsDTES: Downtown Eastside; VANDU: Vancouver area network of drug users;VRP: Vancouver rat projectAcknowledgementsWe would like to thank VANDU with special thanks to Lorna Fay Bird andKevin Benajah Ernest Yake for their ongoing support and recruitment ofparticipants in this study as well as the participants for generously sharingtheir experiences and time. We also thank Dr. David McVea and KelleyJespersen for their insights and assistance in the development of this study,as well as Alissa Greer and Dr. Michael Whitlock for feedback on an earlierversion of this manuscript. Finally, we would like to thank Drs. Louise Lawsonand Danielle German for their constructive reviews, which greatly improvedthis manuscript.Authors’ contributionsThe study was conceived of by KAB and CGH and designed by KAB, SMC, RL,and CGH. Interviews were performed by KAB and RL, transcribed by KAB andreviewed by RL for accuracy. Thematic analysis was undertaken by KAB andSMC who were familiar with the entire dataset. KAB wrote the initial paperwith significant contributions from SMC in drafting and revising. All authorscontributed to the paper’s contents and provided final approval. Fundingwas obtained by KAB, RL, and CGH. All authors have read and approved ofthe final manuscript.FundingThis study was funded by the Public Scholars’ Initiative at the University ofBritish Columbia. The funding body approved of the study aims and had nofurther involvement in design or implementation.Availability of data and materialsThe transcripts generated from interviews in this study are not publiclyavailable because prior consent from participants was only obtained for theresearch team to have full access.Ethics approval and consent to participateThis study was approved for research ethics by the ethics boards ofProvidence Healthcare and the University of British Columbia (H16–02743).Each participant provided written informed consent prior to thecommencement of their interview.Consent for publicationNot applicable.Competing interestsThe authors declare that they have no competing interests.Author details1Department of Interdisciplinary Studies, University of British Columbia,Vancouver, BC, Canada. 2Canadian Wildlife Health Cooperative, Animal HealthCentre, Abbotsford, BC, Canada. 3Biodiversity Research Centre, University ofBritish Columbia, Vancouver, BC, Canada. 4School of Population and PublicHealth, University of British Columbia, Vancouver, BC, Canada. 5The W.Maurice Young Centre for Applied Ethics, University of British Columbia,Vancouver, BC, Canada. 6Animal Health Centre, Abbotsford, BC, Canada.Received: 2 November 2018 Accepted: 19 June 2019References1. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci.2010;1186:125–45.2. Gong Y, Palmer S, Gallacher J, Marsden T, Fone D. A systematic review ofthe relationship between objective measurements of the urbanenvironment and psychological distress. Environ Int. 2016;96:48–57.3. Gee GC, Takeuchi DT. Traffic stress, vehicular burden and well-being: amultilevel analysis. Soc Sci Med. 2004;59:405–14.4. Yang T-C, Matthews SA. The role of social and built environments in predictingself-rated stress: a multilevel analysis in Philadelphia. Health Place. 2010;16:803–10.5. Ward Thompson C, Aspinall P, Roe J, Robertson L, Miller D. Mitigatingstress and supporting health in deprived urban communities: theimportance of green space and the social environment. Int J EnvironRes Public Health. 2016;13:440.6. Maas J, Verheij RA, de Vries S, Spreeuwenberg P, Schellevis FG,Groenewegen PP. Morbidity is related to a green living environment. JEpidemiol Community Health. 2009;63:967–73.7. Pope D, Tisdall R, Middleton J, Verma A, van Ameijden E, Birt C, et al. Qualityof and access to green space in relation to psychological distress: resultsfrom a population-based cross-sectional study as part of the EURO-URHIS 2project. Eur J Pub Health. 2015;28:35–8.8. Weich S, Blanchard M, Prince M, Burton E, Erens B, Sproston K. Mentalhealth and the built environment: cross-sectional survey of individual andcontextual risk factors for depression. Br J Psychiatry. 2002;180:428–33.9. Himsworth CG, Parsons KL, Jardine C, Patrick DM. Rats, cities, people, andpathogens: a systematic review and narrative synthesis of literatureregarding the ecology of rat-associated zoonoses in urban centers. Vector-Borne and Zoo Dis. 2013;13:349–59.10. Lam R, Byers KA, Himsworth CG. Beyond zoonosis: the mental healthimpacts of rat exposure on impoverished urban neighborhoods. J EnvironHealth Res. 2018;81:8–12.11. Clinton JM. Rats in urban America. Public Health Rep. 1969;84:1–7.12. Vadell MV, Cavia R, Suárez OV. Abundance, age structure and reproductivepatterns of Rattus norvegicus and Mus musculus in two areas of the city ofBuenos Aires. Int J Pest Manag. 2010;56:327–36.13. Childs JE, McLafferty SL, Sadek R, Miller GL, Khan AS, DuPree ER, et al.Epidemiology of rodent bites and prediction of rat infestation in new YorkCity. Am J Hyg. 1998;148:78–87.14. Davis DE, Fales WT. The distribution of rats in Baltimore, Maryland. Am JHyg. 1949;49:247–54.15. Jassat W, Naicker N, Naidoo S, Mathee A. Rodent control in urbancommunities in Johannesburg, South Africa: from research to action. Int JEnviron Health Res. 2013;23:474–83.16. German D, Latkin CA. Exposure to urban rats as a community stressoramong low-income urban residents. J Community Psychol. 2016;44:249–62.17. Feng AYT, Himsworth CG. The secret life of the city rat: a review of theecology of urban Norway and black rats (Rattus norvegicus and Rattusrattus). Urban Ecosyst. 2014;17:149–62.18. Davis DE. The characteristics of rat populations. Q Rev Biol. 1953;28:373–401.19. Easterbrook JD, Shields T, Klein SL, Glass GE. Norway rat population inBaltimore, Maryland, 2004. Vector-Borne Zoo Dis. 2005;5:296–9.20. Mair C, Diez Roux AV, Morenoff JD. Neighborhood stressors and socialsupport as predictors of depressive symptoms in the Chicago communityadult health study. Health Place. 2010;16:811–9.21. Wilson-Genderson M, Pruchno R. Effects of neighborhood violence andperceptions of neighborhood safety on depressive symptoms of olderadults. Soc Sci Med. 2013;85:43–9.22. Downey L, van Willigen M. Environmental stressors: the mental health impactsof living near industrial activity. J Health Soc Behav. 2005;46:289–305.23. Yen IH, Yelin EH, Katz P, Eisner MD, Blanc PD. Perceived neighborhoodproblems and quality of life, physical functioning, and depressive symptomsamong adults with asthma. Am J Public Health. 2006;96:873–9.24. Ross CE. Neighborhood disadvantage and adult depression. J Health SocBehav. 2000;41:177–87.25. Perkins DD, Taylor RB. Ecological assessments of community disorder: theirrelationship to fear of crime and theoretical implications. Am J CommunityPsychol. 1996;24:63–107.26. Ross CE, Mirowsky J. Neighborhood disorder, subjective alienation, anddistress. J Health Soc Behav. 2009;50:49–64.27. Gary TL, Stark SA, LaVeist TA. Neighborhood characteristics and mentalhealth among African Americans and whites living in a racially integratedurban community. Health Place. 2007;13:569–75.28. Zahner GEP, Kasl SV, White M, Will JC. Psychological consequences ofinfestation of the dwelling unit. Am J Public Health. 1985;75:1303–7.Byers et al. BMC Public Health (2019) 19:853 Page 12 of 1329. Bachelder AE, Stewart MK, Felix HC, Sealy N. Health complaints associatedwith poor rental housing conditions in Arkansas: the only state without alandlord’s implied warranty of habitability. Front Public Health. 2016;4:263.30. Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban builtenvironment and depression: a multilevel analysis. J Epidemiol CommunityHealth. 2005;59:822–7.31. Mohai P, Pellow D, Roberts JT. Environmental justice. Annu RevEnviron Resour. 2009;34:405–30.32. Panti-May JA, Sodá-Tamayo L, Gamboa-Tec N, Cetina-Franco R, Cigarroa-Toledo N, Machaín-Williams C, et al. Perceptions of rodent-associatedproblems: an experience in urban and rural areas of Yucatan, Mexico. UrbanEcosyst. 2017;20:983–8.33. Marshall PA, Murphy RG. Investigating residents’ perceptions of urbanrodents in Manchester, UK. In: Singleton GR, Hinds LA, Krebs CJ, Spratt DM,editors. Rats, mice and people: rodent biology and management. Canberra:ACIAR; 2003. p. 473–6.34. Bryks S. Analysis of 44 cases before the landlord and tenant boardinvolving bed bug infestations in Ontario, Canada: focus on adjudicatordecisions based on entomological/pest management evidence andaccountability under the residential tenancy act and other applicablelegislation. Insects. 2011;2:343–53.35. Harrison MM. Don’t let the bed bugs bill: landlord liability for bed buginfestations in Georgia. Ga St U L Rev. 2018;34:1–34.36. Masuda JR, Zupancic T, Poland B, Cole DC. Environmental health andvulnerable populations in Canada: mapping an integrated equity-focusedresearch agenda. Can Geogr. 2008;52:427–50.37. National Collaborating Centre for Environmental Health and NationalCollaborating Centre for Determinants of Health. Environmental influenceson population mental health promotion for children and youth. Canada:National Collaborating Centres for Public Health; 2017. p. 1–12.38. McVea DA, Himsworth CG, Patrick DM, Lindsay LR, Kosoy M, Kerr T. Exposureto rats and rat-associated Leptospira and Bartonella species among peoplewho use drugs in an impoverished, inner-city neighborhood of Vancouver,Canada. Vector-Borne Zoo Dis. 2018;18:82–8.39. Swanson J, Mugabo L, Chan K-M. Crisis: rents and the rate of change in thedowntown eastside. Vancouver (Coast Salish Territories): CarnegieCommunity Action Projects Hotel Survey Housing Report; 2018.40. Smith HA. Where worlds collide: social polarisation at the communitylevel in Vancouver's Gastown/downtown eastside. Vancouver:University of British Columbia; 2000.41. Small W, Kerr T, Charette J, Schechter MT, Spittal PM. Impacts of intensifiedpolice activity on injection drug users: evidence from an ethnographicinvestigation. Int J Drug Pol. 2006;17:85–95.42. Sandelowski M. Whatever happened to qualitative description? Res NursHealth. 2000;23:334–40.43. Byers KA, Lee MJ, Donovan CM, Patrick DM, Himsworth CG. A novel methodfor affixing global positioning system (GPS) tags to urban Norway rats(Rattus norvegicus): feasibility, health impacts and potential for trackingmovement. J Urban Ecol. 2017;3:e68496.44. Himsworth CG, Jardine CM, Parsons KL, Feng AYT, Patrick DM. Thecharacteristics of wild rat (Rattus spp.) populations from an inner-cityneighborhood with a focus on factors critical to the understanding of rat-associated zoonoses. PLoS One. 2014;9:e91654.45. Himsworth CG, Miller RR, Montoya V, Hoang L, Romney MG, Al-Rawahi GN,et al. Carriage of methicillin-resistant Staphylococcus aureus by wild urbanNorway rats (Rattus norvegicus). PLoS One. 2014;9:e87983.46. Donovan CM, Lee MJ, Byers KA, Bidulka J, Patrick DM, Himsworth CG.Leptospira spp. in the oral cavity of urban brown rats (Rattus norvegicus)from Vancouver, Canada—implications for rat-rat and rat-humantransmission. J Wildl Dis. 2018;54:635–7.47. Lee MJ, Byers KA, Donovan CM, Bidulka JJ, Stephen C, Patrick DM, etal. Effects of culling on Leptospira interrogans carriage by rats. EmergInfect Dis. 2018;24:356–60.48. Kerr T, Small W, Peeace W, Douglas D, Pierre A, Wood E. Harm reduction bya “user-run” organization: a case study of the Vancouver area network ofdrug users (VANDU). Int J Drug Pol. 2006;17:61–9.49. Jozaghi E, Greer AM, Lampkin H, Buxton JA. Activism and scientific research:20 years of community action by the Vancouver area network of drug users.Subst Abuse Treat Prev Policy. 2018;13:18.50. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving tomeet the trustworthiness criteria. Int J Qual Meth. 2017;16:1–13.51. Himsworth CG, Zabek E, Desruisseau A, Parmley EJ, Reid-Smith R, JardineCM, et al. Prevalence and characteristics of Escherichia coli and Salmonellaspp. in the feces of wild urban Norway and black rats (Rattus norvegicus andRattus rattus) from an inner-city neighborhood of Vancouver, Canada. JWildl Dis. 2015;51:589–600.52. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances andpsychiatric disorders: an opportunity for prevention? J Am Med Assoc.1989;252:1479–84.53. Stansfeld SA, Sharp DS, Gallacher J, Babisch W. Road traffic noise, noisesensitivity and psychological disorder. Psychol Med. 1993;23:977–85.54. Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry.2005;66:1254–69.55. Sygna K, Aasvang GM, Aamodt G, Oftedal B, Krog NH. Road traffic noise,sleep and mental health. Environ Res. 2014;131:17–24.56. Kishikawa H, Matsui T, Uchiyama I, Miyakawa M, Hiramatsu K, Stansfeld SA.Noise sensitivity and subjective health: questionnaire study conductedalong trunk roads in Kusatsu, Japan. Noise Health. 2009;11:111–7.57. Avison WR, Aneshensel CS, Schieman S, Wheaton B. Advances in theconceptualization of the stress process: essays in honor of Leonard I. Pearlin.New York: Springer; 2010.58. Avison WR, Turner RJ. Stressful life events and depressive symptoms:disaggregating the effects of acute stressors and chronic strains. J HealthSoc Behav. 1988;29:253–64.59. Thoits PA. Stress, coping, and social support processes: where are we? Whatnext? Extra Issue. 1995;Extra Issue:53–79.60. Miller DB, Townsend A. Urban hassles as chronic stressors and adolescentmental health: the urban hassles index. Brief Treat Crisis Interv. 2005;5:85–94.61. Landis D, Gaylord-Harden NK, Malinowski SL, Grant KE, Carleton RA, Ford RE.Urban adolescent stress and hopelessness. J Adolesc. 2007;30:1051–70.62. Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav.1978;19:2–21.63. Unger JB, Kipke MD, Simon TR, Johnson CJ, Montgomery SB, Iverson E.Stress, coping, and social support among homeless youth. J Adolesc Res.1998;13:134–57.64. Uchino BN. Social support and health: a review of physiological processespotentially underlying links to disease outcomes. J Behav Med. 2006;29:377–87.65. Derges J, Lynch R, Clow A, Petticrew M, Draper A. Complaints about dogfaeces as a symbolic representation of incivility in London, UK: a qualitativestudy. Crit Public Health. 2012;22:419–25.66. Bond L, Kearns A, Mason P, Tannahill C, Egan M, Whitely E. Exploring therelationships between housing, neighbourhoods and mental wellbeing forresidents of deprived areas. BMC Public Health. 2012;12:48.67. Sheppard AJ, Salmon C, Balasubramaniam P, Parsons J, Singh G, Jabbar A, etal. Are residents of downtown Toronto influenced by their urbanneighbourhoods? Using concept mapping to examine neighbourhoodcharacteristics and their perceived impact on self-rated mental well-being.Int J Health Geo. 2012;11:31.68. Lazarus L, Chettiar J, Deering K, Nabess R, Shannon K. Risky healthenvironments: women sex workers’ struggles to find safe, secure andnon-exploitative housing in Canada’s poorest postal code. Soc SciMed. 2011;73:1600–7.69. Mirowsky J, Ross CE. Social patterns of distress. Ann Rev Sociol. 1986;12:23–45.70. Krieger J, Higgins DL. Housing and health: time again for public healthaction. Am J Public Health. 2002;92:758–68.71. Chu T, Forsting S, Sandhu J, Ramler G, Riley S, Compton M, et al. Enhancedsurveillance to monitor response to a provincial overdose emergency,Canada. Online J Public Health Inform. 2018;10:e112.72. Colvin BA, Jackson WB. Urban rodent control programs for the 21stcentury. Canberra 1999. pp. 243–257.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Byers et al. BMC Public Health (2019) 19:853 Page 13 of 13
Article
Downtown-Eastside (Vancouver, B.C.)
eng
Reviewed
Vancouver : University of British Columbia Library
BioMed Central
Attribution 4.0 International (CC BY 4.0)
Faculty
Rats
Mental health
Public health
Social justice
Qualitative research
“They’re always there”: resident experiences of living with rats in a disadvantaged urban neighbourhood
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