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Neighbourhood-level policing as a racialised gendered stressor: multilevel analysis of police stops and preterm birth in Seattle, Washington
  1. Taylor Riley1,
  2. Jaquelyn L Jahn2,3,
  3. Mienah Z Sharif1,4,
  4. Daniel A Enquobahrie1,5,
  5. Anjum Hajat1
  1. 1Department of Epidemiology, University of Washington, Seattle, Washington, USA
  2. 2Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
  3. 3Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Uiversity, Philadelphia, Pennsylvania, USA
  4. 4Center for the Study of Racism, Social Justice and Health, UCLA, Los Angeles, California, USA
  5. 5Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr. Taylor Riley, Department of Epidemiology, University of Washington, Seattle, WA 98195, USA; striley{at}


Background Most studies capturing the health effects of police violence focus on directly impacted individuals, but a burgeoning field of study is capturing the indirect, community-level health effects of policing. Few empirical studies have examined neighbourhood-level policing, a contextual and racialised gendered stressor, in relation to preterm birth risk among Black and other racially minoritised people.

Methods We spatially linked individual birth records (2017–2019) in Seattle, Washington (n=25 909) with geocoded data on police stops for three exposure windows: year before pregnancy, first and second trimester. We fit race-stratified multilevel modified Poisson regression models predicting preterm birth (<37 gestational weeks) across tertiles of neighbourhood stop rates controlling for individual and neighbourhood-level covariates. For the second trimester exposure window, birth was operationalised as a time-to-event outcome using multilevel Cox proportional hazard models.

Results Neighbourhood stop rates of Black residents was higher compared with White residents, and Black and Asian pregnant people were exposed to the highest median neighbourhood-level stop rates. Black birthing people living in neighbourhoods with more frequent police stops had increased risk of preterm birth across all exposure windows including the year before pregnancy (adjusted risk ratio (aRR): 1.38, 95% CI 1.02 to 1.85), first trimester (aRR:1.74, 95% CI 1.17 to 2.57) and second trimester (aHR: 1.66, 95% CI 1.14 to 2.42). We found null or inverse associations among Asian, Hispanic and White people.

Conclusion Our study adds to the growing evidence documenting associations of higher risk of preterm birth with neighbourhood police stops among Black birthing people. These findings suggest that routine police practices are one aspect of structural racism contributing to racialised perinatal health inequities.

  • Health inequalities

Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from the Washington Department of Health and the Seattle Police Department.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from the Washington Department of Health and the Seattle Police Department.

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  • Contributors Conceptualisation, data curation, visualisation, writing – original draft preparation: TR. Formal analysis, investigation: TR, JLJ, AH. Methodology: all authors. Supervision: AH. Writing – reviewing and editing: DAE, AH, JLJ and MZS. TR accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.