Housing and neighborhood conditions and exposure to cockroaches in three central and eastern European cities
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- Milstead, T.M., Miles, R. & Röbbel, N. J Housing Built Environ (2006) 21: 397. doi:10.1007/s10901-006-9057-2
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Structural disrepair and inadequate maintenance of public spaces in multi-family housing have been shown to be associated with cockroach infestations, which in turn have negative consequences for population health and quality of life. In this study, we take advantage of a recent housing and health survey designed and implemented by the World Health Organization (WHO) Regional Office for Europe. We focus on three cities: Vilnius, Lithuania; Bratislava, Slovakia; and Budapest, Hungary. For each, we investigate whether housing conditions known to be associated with increased exposure to cockroaches—such as poorly maintained open spaces, kitchen windows that don’t close tightly, waste chutes located in the stairwell, leaky roofs, litter in the housing environment, and problems with the water drainage system are more prevalent in panel block buildings than in other types of multi-family housing. Based on logistic regression analyses, we then investigate whether these housing conditions are associated with higher odds of exposure to cockroaches among residents, and whether cockroach exposure varies by tenure type or responsibility for maintenance. We find that, compared to small multi-family buildings, larger proportions of units in both panel block and large multi-family buildings had conditions that have been associated in other studies with increased exposure to cockroaches. Of these, only kitchen windows that don’t close tightly and housing type were significantly associated with increased exposure to cockroaches in this population. In addition, public-sector responsibility for cleaning was highly associated with cockroach exposure. Housing tenure did not consistently influence the findings.
KeywordsCockroachesPanel block housingCentral and eastern European (CEE) countries
The privatization and stabilization of the housing stock in cities transitioning from a centralized to a free-market economy are important elements of overall economic reform. In many countries of the former Soviet Union, the privatization of the housing stock proceeded fairly rapidly, though challenges remain. In this study, we focus on a particular type of construction, panel block housing, which predominates in the countries of Central and Eastern Europe (European Academy of the Urban Environment, 1998). Panel block housing, although sometimes planned as individual units, tends to be clustered in massive ‘estates’ that house a large proportion of the population. This housing type gets its name from the fact that it is constructed from pre-fabricated concrete panels (Fig. 2, p. 5). Two aspects of panel block housing are of particular concern: structural integrity and responsibility for the maintenance and repair of the buildings (Open House International, 2000). Because these buildings were constructed around the same time using low-quality materials and inadequate construction methods, they are quickly falling into structural disrepair (Vilnius Gediminas Technical University, 1998). This housing type predominates in the Central and Eastern European Countries (CEE), the Commonwealth of Independent States (CIS), and the Russian Federation. Political changes in those areas have resulted in the absence of a clear-cut legal responsibility for the maintenance and repair of the buildings (Bonnefoy et al., 2003, p. 332). Both structural disrepair and inadequate maintenance of public spaces have been shown to be associated with cockroach infestations, which in turn have negative consequences for population health and quality of life (Srinivasan, O’Fallon, L., & Dearry, 2003; Eggleston et al., 2005; Cohn et al., 2006).
In this study, we take advantage of a recent housing and health survey designed and implemented by the World Health Organization (WHO) Regional Office for Europe, the Large Analysis and Review of European housing and health Status (LARES). We focus on the three Eastern European cities included in the survey: Vilnius, Lithuania; Bratislava, Slovakia; and Budapest, Hungary. These three capital cities are of particular interest for two reasons: each is in a country that continues to transition from a centralized to a free-market economy; and the stabilization of the housing stock in each of these countries is closely tied to overall economic reform (Pichler-Milanovich, 1994, p. 1097). We investigate whether the housing conditions known to be associated with increased exposure to cockroaches are more prevalent in panel block dwellings than in other types of multi-family housing in each of these three cities, and whether or not they are associated with increased exposure to cockroaches among residents. The conditions we investigate include both structural design features such as location of waste chutes and tightness of windows, as well as indicators of structural disrepair such as leaky roofs and faulty plumbing systems. In addition, we look at the neighborhood-level conditions of litter and the condition of open spaces between buildings. We also examine whether cockroach exposure varies by two social dimensions of housing: whether the occupants own or rent their housing unit; and what party is responsible for maintaining public spaces in the buildings.
2 Housing conditions, exposure to cockroaches, and links to health
2.1 Housing conditions and exposure to cockroaches
In addition to establishing links between pests and housing conditions in general, past studies have shown cockroaches to be associated with multi-family housing (Kang et al., 1987; Koehler, Patterson, & Brenner, 1987; Rosenstreich et al., 1997), as well as with specific housing conditions, some of which are common to multi-family housing, such as green spaces between buildings (Storey, 1986). Open spaces between buildings can become attractants for cockroaches, especially if they are not well maintained. “Improper landscaping around buildings can... cause pest infestation problems... Foliage next to the foundation affords food... Organic mulch of plants next to a building... provides cockroach harborage in warmer climates (Storey, 1986, p. 155).” Dampness in the housing environment has also been linked to increased cockroaches. Cockroaches thrive especially well in warm, moist environments. Leaky water pipes, drains or radiators, condensation inside ducts or dead spaces and roofs that leak may all contribute to a problem with cockroaches (Howard, 1993; Krieger & Higgins, 2002). In addition, the connection between household and neighborhood litter and cockroaches has been well documented (Gold, 2000).
Architectural features, as well as the condition of housing structures, can influence whether or not cockroaches are present. Not only are good waste disposal systems critical to the control of cockroaches (Howard, 1993), but waste chutes that run between floors can provide cockroaches with a moist environment as well as mobility. Howard (1993) uses the case of the Hulme district of Manchester, England to show how poor building design in multi-family housing can lead to infestations. In Hulme, multi-service ducts carried hot water to each unit. These became warm, moist environments in which large populations of German cockroaches built up. Service ducts also ran between the kitchens and bathrooms of each unit, making it easy for cockroaches to move from kitchen to kitchen around the estate (p. 278).
Based on evidence from past studies (Howard, 1993; Kreiger & Higgins, 2002), we expected to find an association between multi-family housing and housing conditions reflecting structural defects (windows that don’t close tightly, excess moisture or dampness in the home), as well as an association between those defects and exposure to cockroaches, with the possibility of highest exposure in panel blocks. We further anticipated that the analysis would show an association between neighborhood-level variables reflecting decay (littered housing environments, poorly maintained open spaces) and exposure to cockroaches.
Because of its current policy relevance, we also investigated whether exposure to cockroaches was associated with a particular arrangement for cleaning shared spaces. Others have noted that political changes in the CEE countries and the CIS have resulted in a lack of clear-cut legal responsibility for the maintenance and repair of panel block buildings (Bonnefoy et al., 2003, p. 332).
2.2 Exposure to cockroaches and health consequences
The most commonly cited health effects resulting from exposure to cockroaches are respiratory ailments, including asthma, as well as gastrointestinal disorders. Research has shown a positive statistical correlation between exposure to cockroach allergens and episodes of asthma among children (Gergen et al., 1990; Rosenstreich et al., 1997). The source of these allergens is thought to be cockroach feces or body parts, or other sources on the body. These allergens can be found in residences, schools, as well as work areas. They are most commonly found in kitchens where there is a source of food and water. Studies suggest that there is a relationship between cockroach allergen exposure and place of residence (IOM, 2000).
In addition to the effects of cockroach exposure on respiratory health, cockroaches have also been shown to be vectors of bacteria and other pathogens that can cause gastrointestinal and other ailments (Elgderi et al., 2006). Because cockroaches walk through fecal matter and other breeding grounds for germs and then walk across foodstuffs or even across the faces of sleeping individuals from which they eat food particles, exposure to cockroaches in the home greatly increases the risk of gastrointestinal or other vector-borne illnesses.
3.1 Data source
This study is based on the WHO LARES data collected in each of the three CEE cities during 2002 and 2003 (Bonnefoy et al., forthcoming). Three survey instruments were used to assess housing conditions and their links to health. First, a questionnaire was administered to an informant from each household in a face-to-face interview. It included information on the respondent’s satisfaction with his or her home, immediate neighborhood and community, on the informant’s perception of the general condition of the building, on the socioeconomic status (SES) of the household, housing-related expenditures, and on selected lifestyles of household members. This questionnaire also included questions about pest infestations in the dwelling.
Second, trained surveyors recorded their observations about housing conditions and the immediate environment on an inspection sheet. No measurements were made; instead, surveyors documented visible consequences of factors such as humidity and temperature. For example, they reported the presence of molds, draft-proofing devices, and supplemental heating devices. Third, each member of the household was asked to complete a self-administered health questionnaire. This included questions about perceived health status as well as descriptive information about the individual’s health.
3.2 Study population
In the three cities in this study, 82% of households live in multi-family housing, and 18% live in single-family housing. As expected, exposure to cockroaches was much greater among those living in multi-family housing (18%) than among those in single-family dwellings (2%) (p-value: 0.000). In this study we limit ourselves to multi-family housing types. The WHO LARES database included information for three multi-family housing types that are the focus of this study: (1) panel block; (2) small multi-family housing (apartment blocks with no more than six units); and (3) large multi-family housing (apartment blocks with more than six units). In this study, a total population of 1,239 households was used in the analysis of housing and neighborhood conditions and exposure to cockroaches. Unlike many studies that look at neighborhood effects, because the households in this study were randomly selected from population registries in each city, it was not necessary to adjust the standard errors for clustering.
3.3 Variables used in the analysis
Variable definitions based on self-reports
Current exposure to cockroaches
Yes: household reports cockroaches either in the present, or in both the past and the present
No: household reports never having been exposed to cockroaches
Trouble with water drainage
Yes: household reports having trouble with the drainage system at any point in the past
No: household reports never having had trouble with the water drainage system
Presence and location of waste chute
Yes: Presence of a waste chute in building
No: No waste chute or waste chute in dwelling
Satisfaction with bathroom installations
Yes: household reports high to moderate satisfaction
No: household reports low to very low satisfaction
Yes: Roof is not waterproof or leaks
No: Roof is waterproof
Household socio-economic status (SES) (based on composite score)
Responsibility for cleaning of the building and staircases
Private owner: One or several private owners, or a private owner that is renting the dwelling out
Rental household: Households that live in rented dwelling
Public sector agency: a housing agency, municipality, cooperative, or building administrator
Housekeeper: A special person who is paid for doing these tasks, lives in the house or close to it, and knows the people
Service company: Cleaning staff of any kind that has been contracted
Variable definitions based on direct observation by inspectors
Tightness of bathroom window
Bathroom window does not close tightly: i.e., has a visible gap or produce a draught
No window in the bathroom; or window closes tightly
Tightness of kitchen window
Kitchen window does not close tightly: i.e., has a visible gap or produces a draught
No window in the kitchen; or window closes tightly
Panel block: built of pre-fabricated panel elements
Multi-family housing: consisting of several flats
Small multi-family buildings: up to six residential units
Large multi-family buildings: more than six residential units
Composite index combining scores for the following indicators of neighborhood decay: (1) Litter in housing environment (0 = None; 1 = Some); and (2) Condition of open space between buildings (0 = No open space or space well maintained; 1 = Space poorly maintained). Index values range from 0 to 2
Presence of open space
Yes: presence of open green space between buildings, excluding private gardens
No: no open green space between buildings
City of residence
3.4 Measuring current exposure to cockroaches
In this study, we use the information on presence of pests obtained from the household informant with a matrix question asking “in the past 12 months until now, which of the following pests are—or were—present in your dwelling?” Response options are ‘never,’ ‘in the past,’ ‘at present,’ and ‘in the past and at present.’ The LARES database does not distinguish types of cockroaches. For the analysis, we created a measure of current exposure to cockroaches that combines households reporting cockroaches in the present with those reporting them in both the past and present.
3.5 Statistical analysis
We used logistic regression and the odds ratio (OR) as a measure of effect between current cockroach exposure and neighborhood and housing-level exposures. We estimated adjusted ORs and 95% confidence intervals in a series of logistic regression analyses, first including only housing type and city of residence, then adding SES and housing tenure and finally adding the full set of neighborhood and housing conditions. In the full model, covariates include housing type, SES, housing tenure, problems with water drainage, presence and location of a waste chute, level of neighborhood decay, tightness of kitchen window, tightness of bathroom window, and responsibility for maintenance of corridors and stairwells. An indicator of city of residence was included in all of the analyses to account for unmeasured city-level influences on cockroach exposure such as differences in temperature. Statistical interactions between city or residence, tenure, SES, litter, neighborhood decay, and responsibility for tenure were tested. None were statistically significant, so they are not reported here. The housing and neighborhood conditions included in the model were chosen on the basis of their theoretical significance to exposure to cockroaches.
4.1 Housing type and exposure to cockroaches
Current exposure to cockroaches was reported in 18% of households in the study population. Current exposure is defined as exposure either in the present or in both the past and the present. Of those households reporting a current exposure to cockroaches, the largest percentage (20%) lived in panel block buildings, followed by residents in large multi-family buildings (17%). Seven percent of the residents in small multi-family buildings reported current exposure.
4.1.1 City, housing type, home ownership and responsibility for maintenance
City by housing type and home ownership
PBs owned (%)
Large MFs owned (%)
Small MFs owned (%)
City by responsibility for cleaning
Owner responsible (%)
Renter responsible (%)
Service co. responsible (%)
Housekeeper responsible (%)
Public sector responsible (%)
4.1.2 Housing type, age of buildings, SES and housing conditions
Mean SES score by building age
Buildings built 1961–1970
Buildings built 1971–1980
Buildings built 1981–1990
Buildings built 1991 and later
Mean SES score
Mean SES score by housing type
Mean SES score
4.1.3 Housing type and housing conditions
Housing conditions by housing type
Panel block (%)
Small MFa (%)
Large MFb (%)
Poorly kept open/green space
Dirty waste chute in stairwell
Satisfied w/bathroom installations
Trouble w/water drainage
Win. In kitchen
Win. In bathroom
Non-tight kitchen window
Non-tight bathroom window
Table 7 also shows that, compared to other types of multi-family housing, panel blocks were more likely to have poorly maintained waste chutes located in stairwells. Satisfaction with bathroom installations was also noticeably lower among panel block residents and residents of large multi-family buildings compared to residents of small multi-family buildings. In contrast, as shown in Table 7, a slightly smaller proportion of residents of panel block buildings reported having had problems with the water drainage system at some point compared to residents of either large or small multi-family buildings.
Similarly, Table 7 shows that leaky roofs, important sources of indoor moisture, were most prevalent among large multi-family buildings, not among panel blocks. Kitchen windows, on the other hand, were fairly common across housing types, although slightly more prevalent among panel blocks. Also, a higher percentage of panel blocks than other multi-family housing types had kitchen windows that did not close tightly. The tightness and location of windows, especially in bathrooms and kitchens, are important because these rooms provide cockroaches with sources of food and moisture.
4.1.4 Housing types and arrangements for cleaning public spaces
Housing type by responsibility for cleaning
Privately owned (%)
Owner responsible (%)
Renter responsible (%)
Service co. responsible (%)
Housekeeper responsible (%)
Public sector responsible (%)
4.2 Results of binary logistic regression
4.2.1 Housing conditions and exposure to cockroaches
In our study, the independent variables were included in the binary logistic regression model in blocks of conceptually related variables for the purpose of observing how the relationships between the independent and dependent variables changed as new groups of variables were added to the model. For instance, the first iteration of the model included only housing type as the independent variable. The second iteration of the model included housing type, SES, and tenure (owned or rented). The third and final iteration of the model, the full model, included as independent variables housing type, SES, tenure of the occupant, presence of a waste chute in the stairwell, presence of non-tight kitchen window, presence of non-tight bathroom window, trouble with water drainage, presence of one indicator of neighborhood decline, and presence of two indicators of neighborhood decline.
Odds ratios measuring the effect of housing type on exposure to cockroaches
Panel blocks versus small multi-family housing (SMF)
Large multi-family housing (LMF) versus SMF
Renter versus owner
Waste chute in stairwell versus waste chute in dwelling or no waste chute
Non-tight kitchen window versus tight kitchen window or no window
Non-tight bathroom window versus tight bathroom window or no window
Trouble with water drainage at some point versus never
One indicator of neighborhood decline (litter or poorly maintained open space) versus none
Two indicators of neighborhood decline versus none
Owner responsible for cleaning corridors and stairwells versus private cleaning company
Renter responsible for cleaning corridors and stairwells versus private cleaning company
Housekeeper responsible for cleaning corridors and stairwells versus private cleaning company
Public sector responsible for cleaning corridors and stairwells versus private cleaning company
Furthermore, in the full model with all the covariates (Model 3), the effect of residence in panel block buildings remained substantial and significant. Compared to residents of small multi-family buildings, those in panel blocks had almost three times higher odds of exposure to cockroaches, and residents of large multi-family buildings had over twice the odds of being exposed. Public-sector responsibility for cleaning public spaces came through as an equally important risk factor for cockroach exposure. Residents in buildings where the public sector was responsible for cleaning corridors and stairwells, compared to residents in buildings where a private cleaning company was responsible, had over twice the odds of exposure to cockroaches. As for structural design, non-tight kitchen and bathroom windows and waste chutes in the stairwell all substantially increased the odds of cockroach exposure, although the results did not reach significance in the full model for the latter two.
In summary, compared to small multi-family buildings, our findings indicate that larger proportions of units in both panel block and large multi-family buildings had dwelling-level and neighborhood-level conditions that have been associated in other studies with increased exposure to cockroaches. Poorly maintained open spaces, kitchen windows that don’t close tightly, and waste chutes located in the stairwell were more common in panel block buildings, whereas leaky roofs, litter in the housing environment, and problems with the water drainage system were more common in large multi-family buildings than in panel blocks. When all of these are considered together in a regression model, only kitchen windows that don’t close tightly and housing type were significantly associated with increased exposure to cockroaches. In addition, public-sector responsibility for cleaning—an arrangement more common in panel block and large multi-family housing than small buildings—was highly associated with cockroach exposure. Housing tenure did not consistently influence the findings, nor were there any significant interactions between city of residence and tenure, responsibility for cleaning and amount of litter, tenure and responsibility for cleaning, or tenure and level of neighborhood decay.
As expected, the findings indicate that the size of the multi-family building plays a role in cockroach exposure: residents of larger buildings are at greater risk. However, the finding that has the most practical significance is the one related to public-sector responsibility for cleaning shared spaces in buildings. The research showed that units in panel block housing, followed by large multi-family buildings, have the highest percentage of residents reporting that the public sector is responsible for cleaning, and public-sector responsibility for cleaning is associated with an increase in exposure to cockroaches. This finding would seem to argue for a re-evaluation of the importance of neighborhood maintenance issues in urban policy discourse. The findings of this research suggest that interventions are needed to improve the capacity of public-sector agencies that are responsible for cleaning buildings. This is especially true in the countries of Central and Eastern Europe where a large percentage of the housing stock is panel block and large multi-family buildings that are maintained by such public-sector agencies. To develop the practical policy implications of this finding, more in-depth investigation of different maintenance practices is needed.
Also important from a policy perspective is the determination whether, and in which cities, ‘private cleaning service’ denotes large state-owned enterprises or newly formed smaller companies that have emerged as a result of targeted market and housing reform initiatives. Similarly important would be an understanding of whether, and to what extent, ‘housekeeper’ denotes a gainfully employed semi-skilled worker as opposed to a member of a disenfranchised minority group providing an irregular service, as is often the case in Eastern European countries.
In addition, this research suggests that while panel block housing conditions were generally found to be poor in this and other studies, some indicators of poor housing or neighborhood conditions, such as leaky roofs, litter, and trouble with the water drainage system, were more prevalent among large multi-family housing than among panel block housing. The significance of this finding is that it suggests that panel block housing, long recognized for its sub-standard construction and state of disrepair, is not necessarily the worst type of Eastern European housing to live in and that large multi-family housing might, in some respects, be in poorer shape. However, the fact that residents of panel block housing had three times higher odds of having been exposed to cockroaches than residents of smaller buildings, compared to residents of large multi-family buildings who had only twice the odds, is an important finding. This suggests that there could be something endemic to these housing types themselves that is leading to cockroach infestations. Possible causes include the increased human density associated with panel block housing compared to other types of multi-family housing, as more people living together could provide an environment in which cockroaches are more likely to find food and water. In any event, the data clearly show that two components are coming together to affect pest infestations: the building type itself and the maintenance arrangements within a building. Therefore, future research and policy focusing on panel block and large multi-family housing in the study area would be well advised to consider both the structural and social/administrative aspects of the problem.