Police Exposure As a Determinant of Structural Racism: An Exploration of the Association between Preterm Birth in Neighborhoods with High Police Exposure
Authors: Hardeman R. , Chantarat T. , Karbeah J. 
Published: August 2020

Research ObjectiveIn the United States, Black infants are twice as likely than their white counterparts to experience preterm birth (PTB)—an inequity that has existed for decades. Forms of structural racism such as residential segregation have recently been associated with PTB. Segregated communities are often disproportionately exposed to police contact. Little is understood about how simply living in a community that experiences disproportionate police contact may impact PTB. Our objective is to assess whether high exposure to police contact is associated with PTB.Study DesignNeighborhood police exposure was measured at the census tract level with police incident data extracted from the Minneapolis Police Incident Report (2012‐2016). The 5‐year cumulative count of police incidents of all offense types was calculated for each census tract. This cumulative count ranged from 10 to more than 9000 incidents during these 5 years which likely reflects heterogeneity in neighborhood vigilance or that census tracts with a larger number of residents were more likely to have more police incidents. To account for the latter, we categorized each census tract into neighborhoods with high (fourth quartile) vs low (first to third quartile) police exposure and included census tract population estimate as a covariate along with marital status, maternal age at the time of delivery, insurance status, diagnosis of diabetes (prepregnancy and gestational), and hypertension. All population estimates were from the 2016 American Community Survey 5‐year estimates. We mapped 5‐year cumulative police incident count and proportion of Black residents to visually assess relationships. We also test for correlation of the incident count and the proportion of Black residents. To examine the association between the neighborhood police exposure and PTB, we constructed multivariate multilevel generalized linear regression models, adjusting for correlated data of women who lived in the same census tract, and estimated robust standard errors with the sandwich estimator.Population StudiedThe analytic sample included Black and White women who gave birth to live singletons from January 1 to December 31, 2016 and lived in one of the 116 census tracts that make up the City of Minneapolis plus the 15 bordering census tracts.Principal FindingsWhen the measure of neighborhood police exposure, census tract population estimate, and the woman’s racial group were regressed on PTB, we observed an 83% increase in the odds of PTB among those who resided in the neighborhood with high police exposure relative to those in the low exposure neighborhood (OR = 1.83, CI: 1.01‐3.32). When maternal and census tract median household income was controlled for, we observed a slightly larger magnitude of our association of interest (OR = 1.99, CI: 1.00‐3.96).ConclusionsA high level of neighborhood police exposure increases the risk of PTB among women of all racial groups. However, since neighborhoods with greater proportion of Blacks residents are more likely to be policed, the higher incident of PTB among Black than White women may be attributed to racialized pattern of exposure rather than differential effect between the two groups.Implications for Policy or PracticePolice contact, specifically routine stops conducted by police departments as a crime deterrent measure, may impact health outcomes.Primary Funding SourceUniversity of Minnesota Institute for Diversity, Equity and Advocacy Multicultural Research Award.