Public Health Policy Analysis (PHPA) Paper

Aggressive Policing and the Mental Health of Young Urban Men Amanda Geller, PhD, Jeffrey Fagan, PhD, Tom Tyler, PhD, and Bruce G. Link, PhD

The criminal justice system has been recog- nized increasingly as a threat to physical and mental health.1---3 Changes in policing practices in the past 2 decades have brought a growing number of urban residents into contact with the criminal justice system,4 making the con- sequences of such contact increasingly im- portant to understand. In the past 20 years, many cities have shifted to a proactive polic- ing model in which officers actively engage citizens in high-crime areas to detect immi- nent criminal activity or disrupt circum- stances interpreted as indicia that “crime is afoot.”5

One way proactive policing is sanctioned constitutionally is through a tactic known as Terry stops,6 in which police temporarily de- tain and perhaps frisk or search persons they suspect are, were, or are about to be engaged in criminal activity. Between 2004 and 2012, the New York City Police Department recorded more than 4 million such stops.7 Large cities such as Philadelphia, Pennsylvania,8 and Los Angeles, California,9 have experienced similar practices, and a survey of Chicago, Illinois, public school students10 found that police had stopped and questioned about half and “told them off or told them to move on.” A quarter to a third of these students reported having been searched by police. Overall, the burden of police contact in each of these cities falls predominantly on young Black and Latino males,8,10,11 with significant disparities in police conduct across neighborhoods.12,13

Recent studies suggest that Terry stops are often harsh encounters in which physical vio- lence, racial/ethnic degradation, and homopho- bia are commonplace,14,15 raising the potential for adverse mental health effects. We examined associations between involuntary police contact and mental health among young men in New York City, where Terry stops and proactive policing (commonly known as “stop and frisk” activity) have been the subject of contentious debate and litigation.11,16,17

Public perceptions of stop and frisk vary widely, with some observers raising concerns about the aggressive nature of many stops18

and their shaky constitutional grounds.19

Others dismiss these concerns as outweighed by the benefit of crime deterrence20 or as inconveniences that should be accepted as a “fact of urban life.”21

Most of what is known about New Yorkers’ police contact is derived from observational incident-level data,12,16 journalistic accounts,18,19,21

or convenience samples22 and suggests a com- plex and conflicted relationship between com- munity members and the police. However, such accounts provide only limited insight into the broader implications of the practice. We have advanced understanding of the cumula- tive experiences of young men with these police encounters using a population-based survey.

BACKGROUND

Police contact may threaten the health of individuals stopped in several ways. In New York City, approximately half of recorded stops involve the physical contact of a frisk, and

officers describe approximately 20% as in- volving the “use of force.”11 The physically invasive, often rough manner in which officers approach citizens raises the risk of injury. Qualitative research suggests that young men are often thrown to the ground or slammed against walls in these encounters.15,23 Individ- uals stopped by the police may also face emo- tional trauma from such treatment in the face of unwarranted accusations of wrongdoing.

Proactive police stops are predicated on low levels of suspicion and rarely result in arrest, summons, or seizure of contraband,12 suggest- ing that the vast majority of individuals stopped have done nothing wrong.24 Contacts of this nature may trigger stigma and stress responses and depressive symptoms.25 These stresses can be compounded when police use harsh lan- guage, such as racial invective or taunts about sexuality.14 Finally, to the extent that individ- uals stopped believe that they were targeted because of their race or ethnicity or may be targeted again, they may experience symptoms tied to the stresses of perceived or anticipated racism.26,27

On the other hand, a visible, proactive police presence can improve individual and

Objectives. We surveyed young men on their experiences of police encounters

and subsequent mental health.

Methods. Between September 2012 and March 2013, we conducted a population-

based telephone survey of 1261 young men aged 18 to 26 years in New York City.

Respondents reported how many times they were approached by New York

Police Department officers, what these encounters entailed, any trauma they

attributed to the stops, and their overall anxiety. We analyzed data using

cross-sectional regressions.

Results. Participants who reported more police contact also reported more

trauma and anxiety symptoms, associations tied to how many stops they reported,

the intrusiveness of the encounters, and their perceptions of police fairness.

Conclusions. The intensity of respondent experiences and their associated

health risks raise serious concerns, suggesting a need to reevaluate officer

interactions with the public. Less invasive tactics are needed for suspects who

may display mental health symptoms and to reduce any psychological harms to

individuals stopped. (Am J Public Health. 2014;104:2321–2327. doi:10.2105/

AJPH.2014.302046)

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population health through improved public safety and feelings of security.28 Although these benefits may accrue predominantly to those not personally stopped, even youths who experience aggressive police contact may re- ceive safety benefits along with any adverse effects.29 In addition, the literature on pro- cedural justice29---31 suggests that police en- counters conducted fairly and respectfully can enhance police---community relations and promote the well-being of those stopped.

Despite the heated debate on police prac- tices,18,20,21 little is known about the health implications of involuntary contact with the police. Shedd32 suggests high rates of distress and perceptions of injustice among Chicago youths who are stopped, whereas Brunson and Weitzer15 identify feelings of “hopelessness” and being “dehumanized.” These studies paint a rich picture of aggressive policing experi- enced by many youths and suggest the poten- tial for health consequences; however, these links have not been tested. Limited data are available to assess the health implications of police encounters, particularly for the urban youths at greatest risk for contact.

METHODS

We fielded a population-based survey of young men in New York City on the extent and nature of their experiences with the police and the association between these contacts and di- mensions of their mental health. Between Sep- tember 2012 and March 2013, we surveyed men aged 18 to 26 years, reflecting the demographic concentration of police stops in that age bracket. We selected participants using a stratified random sample dividing New York City into 146 “neigh- borhood clusters,” combinations of the city’s 295 neighborhoods33 that are geographically adjacent and of comparable racial/ethnic composition and median income. We stratified these clusters into deciles on the basis of the number of stops recorded in 2008 and 2009 and randomly sampled clusters within deciles.

We recruited 1261 participants from 37 clusters using a combination of random digit dialing and consumer telephone lists (including both landline and cell phone numbers) and surveyed them by telephone. When the person answering the telephone was a male resident of New York City aged 18 to 26 years, interviewers

invited him to participate—interviewers asked others answering the telephone to refer a male resident aged 18 to 26 years in the household. Participants received a $25 incentive for their involvement.

The American Association for Public Opinion Research minimum response rate (i.e., the number of complete interviews divided by the total number of interviews, noninterviews, and cases of unknown eligibility34) was 32%. The American Association for Public Opinion Research minimum cooperation rate (i.e., the proportion of eligible respondents completing the survey) was 52%. The survey lasted ap- proximately 25 minutes and asked participants about their experiences with the New York City Police Department, their perceptions of police conduct during these encounters, and their recent mental health.

Measurement

Interviewers asked participants about their experiences with the police: whether and how many times they had been stopped, where the encounters took place, and police conduct during the encounter, including whether offi- cers asked them to show identification, frisked or searched them, used harsh or racially tinged language, or threatened or used physical force. Individuals stopped multiple times reported on their most memorable incident (their “critical encounter”). We combined these indicators into an additive scale of police intrusion (a = .68) in the respondent’s critical encounter. Police intrusion and other scale items are available as a supplement to the online version of this article at http://www.ajph.org. Participants also reported their perceptions of procedural justice—the procedural fairness, interpersonal respect, and ethicality with which the police exercised their authority—in their critical en- counter35 and globally,36 with higher values indicating more just procedures (a = .94 and a = .83, respectively).

Respondents reported on 2 domains of mental health. Those stopped by the police completed an Impact of Event Scale---Revised, which assessed symptoms of trauma related to recent stressful events.37 The scale contains 3 subscales (intrusion, avoidance, and hyper- arousal) summed to measure posttraumatic stress disorder (PTSD; a = .78). In addition, all participants, with and without police experience,

reported their anxiety levels using the Brief Symptom Inventory38 anxiety subscale (a = .84), with high scores indicating more distress.

Finally, because mental health outcomes are multiply determined, and many factors pre- dicting health are also correlated with police contact, our analyses controlled for several demographic and socioeconomic covariates, including self-reported race/ethnicity, educa- tional attainment, residence in public housing, and criminal activity, on the basis of a 5-item variety score (a = .61).39,40

Analytical Approach

We first estimated the probability that par- ticipants experienced the “treatment” of contact with the police in the year leading up to their interview as a function of their race/ethnicity, age, education, criminal participation, public housing residence, and neighborhood cluster. This model, which we call model 0, allows estimation of a predicted probability of the “treatment” of being stopped. In subsequent models we followed Bang and Robins41 by predicting mental health and controlling for the inverse probability of treatment as a proxy for selection into police contact.

We estimated all mental health models using ordinary least squares regressions with robust SEs and fixed effects for neighborhood cluster. We estimated SEs to reflect the multiple impu- tation. We next examined the associations be- tween self-reported police contact and mental health. In model 1, we estimated the extent to which the number of times the police stopped respondents predicted mental health (anxiety or PTSD), controlling again for covariates (race/ ethnicity, education, residence in public housing, and criminal activity) and neighborhood fixed effects as well as the selection parameter.

In model 2, we assessed the implications of both the volume of contact participants experienced and how they were treated in their critical encounter. This model replicated the first, estimating an effect of intrusive treatment in reported critical stops. In the anxiety model, which included respondents not stopped in the previous year, we identified those not stopped by a dummy variable, and they had an “intrusion” index of zero as well as their estimated selection parameter.

Finally, we assessed the role of the pro- cedural justice context in predicting mental

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health, particularly whether perceived proce- dural justice moderated the associations be- tween stop conduct and mental health. Model 3 replicated model 2, adding controls for perceived procedural justice in the respon- dents’ critical encounter and globally. Model 3 also included interactions between both mea- sures of procedural justice and the indicator of invasive treatment.

We hypothesized that both health outcomes were linked to stop experience but that these links were largely tied to how respondents were treated in the course of stops. We expected that people reporting more intrusive critical stops would experience more mental health symptoms; however, we expected fewer symptoms among those who perceived more procedural justice in police activity. Moreover, we hypothesized that perceived procedural justice would attenuate any adverse associa- tions between health and invasive stop activity.

Analysis Samples

We estimated each model for all respon- dents reporting the outcome of interest. We imputed missing data on predictor variables using the MI procedure in Stata version 12.0 (StataCorp LP, College Station, TX).42 We have reported results derived from imputed data, with subsequent discussion of sensitivity to complete case analysis.

We have reported results derived from an unweighted sample, with subsequent discus- sion of sensitivity to a weighting strategy that reflects the oversample of high-stop neighbor- hoods and the mix of random digit dialing and list-based sampling.

RESULTS

Table 1 shows that consistent with the neighborhood sampling strategy, respondents were predominantly racial and ethnic minorities (80.00% non-White), young (average age = 22 years), more likely to have completed high school than are those aged 18 to 26 years citywide (87.71% vs 82.86% of those aged 18---26 years in New York City33), but less likely to have completed college (19.19% vs 24.57%33). Nearly 13.00% reported living in public housing. The measure of respondents’ self-reported criminal activity was highly skewed, with 78.00% of respondents reporting

no criminal activity, and a small number of respondents (;3.00%) reporting 3 or more types of illegal activities.

Respondents reported high rates of police contact; 85% reported at least 1 police stop, and 46% reported being stopped at least once in the year they were surveyed. Like the distribution of criminal involvement, the dis- tribution of police contact was highly skewed. Although 80% of respondents reported being stopped 10 times or fewer, more than 5% of respondents reported being stopped more than 25 times, and 1% of respondents reported more than 100 stops.

Probability of Police Contact

Individuals reporting more extensive criminal histories faced a greater probability of having been stopped (P < .001); differences in stop probability by race/ethnicity, educational

attainment, and public housing residence were not statistically significant at traditional levels.

The lack of observed racial/ethnic differences in model 0 was notable because of the extreme racial/ethnic differences observed in citywide stop patterns, but it is largely explained by the control for neighborhood cluster, an association that has also been observed citywide.11

Health Outcomes

Tables 2 and 3 and Figure 1 show the associations between reported police contact and mental health. Model 1 shows that young men who reported more police contact also reported higher anxiety scores, controlling for their demographic characteristics and criminal involvement. Other observed factors were also significant predictors: respondents who reported higher levels of criminal in- volvement reported more anxiety, although

TABLE 1—Summary Statistics of Analysis Sample of Observed Cases: Survey of Associations

Between Police Contact and Mental Health, New York City, September 2012–March 2013

Variable Mean (SD) or %

Health outcomes

Anxiety (BSI subscale, asked of all) 8.53 (6.89)

Trauma (IES–R, asked if stopped in the past year) 3.49 (2.58)

Race/ethnicity

White 20

Black 30

Hispanic 35

Other or unknown 15

Respondent age, y 22.03 (2.50)

Education

Did not complete high school 12

High school graduate only 31

Some college or technical training 37

College graduate or more 19

Public housing residents 13

Self-reported criminal activity 0.32 (0.75)

Experience with the police

Ever stopped 85

Number of stops in lifetime 8.64 (17.86)

Stopped past year 46

Perceived procedural justice, global 17.84 (6.23)

Critical stop experience, asked if stopped in the past year

Perceived procedural justice, critical encounter 28.57 (13.40)

Intrusion scale 3.43 (2.38)

Note. BSI = Brief Symptom Inventory; IES–R = Impact of Event Scale–Revised. Percentages may not total 100 because of rounding.

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Black and Hispanic respondents reported significantly less anxiety than did White respon- dents. Differences by race/ethnicity and criminal involvement were robust across models.

Model 2 shows that anxiety symptoms were significantly related to the number of times the young men were stopped and to how they perceived the critical encounter was con- ducted. In model 2, respondents who reported more police intrusion reported higher anxiety scores. Model 3 also suggested greater anxiety among respondents reporting more police in- trusion, a relationship whose magnitude in- creases when considering procedural justice but that marginally loses statistical significance (P = .053). In model 3, respondents who per- ceived greater “global procedural justice” reported significantly less anxiety; however, procedural justice in respondents’ critical en- counters was not significantly related to anxiety.

Any procedural justice attenuation of the relationship between stop intrusion and anxi- ety was small in magnitude and statistically insignificant (as indicated by the 2 negative interaction terms). Figure 1a presents predicted levels of anxiety as a function of stop intrusion (adjusted for the covariates and interactions of model 3) and suggests an association that grows stronger among respondents reporting more intrusive critical encounters.

Table 3 presents estimates from models predicting PTSD (e.g., the Impact of Event Scale---Revised) associated with respondents’ critical encounters with the police. Model 1 indicated more trauma symptoms among re- spondents reporting more lifetime stops. In this model, trauma levels were also significantly higher among public housing residents. The significance of these relationships was robust to a control for stop intrusion, presented in

model 2, although their magnitudes were at- tenuated. In model 2, stop intrusion was a sig- nificant predictor of PTSD, with more invasive stops predicting higher levels of trauma.

Model 3, which also considered the role of procedural justice, suggests that the stop intrusion remained a statistically significant predictor of PTSD but lost more than one third of its magnitude. Perceived procedural justice in respondents’ critical encounters (although not global procedural justice) was inversely related to trauma: young men who reported fair treatment in these encounters reported fewer PTSD symptoms. As with the anxiety models, the extent to which procedural justice moderated the association between stop in- trusion and related trauma was relatively small.

Although statistically significant, the inter- action effects of global and critical stop pro- cedural justice were in offsetting directions. As shown in Figure 1b, the association between stop intrusion and predicted PTSD is particularly strong at high levels of intrusion (> 5 of 14).

DISCUSSION

Although proactive policing practices target high-crime, disadvantaged neighborhoods, af- fecting individuals already facing severe socio- economic disadvantage, our findings suggest that young men stopped by the police face a parallel but hidden disadvantage: compro- mised mental health. We found that young men reporting police contact, particularly more intrusive contact, also display higher levels of anxiety and trauma associated with their experiences. Although respondents per- ceiving greater procedural justice from the police report fewer symptoms, stop intrusion remains tied to mental health (marginally in the case of anxiety and significantly in the case of PTSD).

Observed health implications are strongest in the most intrusive encounters; this can be seen most clearly in Figure 1b, in which predicted PTSD symptoms rise sharply at intrusion levels of 5 or more. Notably, the skewed distribution of stop intrusion suggests that this association is driven by the 25% of respondents recently stopped who report intrusion in this range. Although this repre- sents a minority of our sample (10% overall), the group is nonnegligible; that so many

TABLE 2—Estimated Predictors of Anxiety Symptoms (BSI Subscale) Ordinary Least Squares

Parameter Estimates and SEs: Survey of Associations Between Police Contact and Mental

Health, New York City, September 2012–March 2013

Variable Model 1, b (SE) Model 2, b (SE) Model 3, b (SE)

Stops

Total lifetime 0.05** (0.02) 0.04* (0.01) 0.02 (0.01)

Any past year, yes or no –0.96 (0.59) 0.15 (1.44)

Intrusion 0.43*** (0.14) 0.55 (0.28)

Procedural justice

Global –0.12* (0.05)

Critical stop –0.01 (0.04)

Global · intrusion –0.01 (0.02) Critical · intrusion –0.01 (0.01)

Selection parameter, IPT –0.41 (0.78) –0.34 (0.77) –0.16 (0.77)

Race/ethnicity

Black –2.05** (0.76) –2.11** (0.76) –2.36** (0.75)

Hispanic –1.81** (0.64) –1.84** (0.64) –1.80** (0.62)

Other or unknown –0.55 (0.79) –0.64 (0.79) –0.76 (0.77)

Education

< high school 0.88 (0.77) 0.77 (0.76) 0.65 (0.74)

Some college or technical school 0.16 (0.48) 0.18 (0.64) 0.08 (0.48)

College graduate –0.89 (0.58) –0.78 (0.76) –0.91 (0.58)

Self-reported criminal activity 1.58*** (0.47) 1.44** (0.46) 1.37** (0.45)

Public housing 0.80 (0.77) 0.58 (0.76) 0.48 (0.76)

Neighborhood FE included, yes or no Yes Yes Yes

Number of observations per imputation 1229 1229 1229

Note. BSI = Brief Symptom Inventory; FE = fixed effects; IPT = inverse probability of treatment. Analyses are derived from multiply imputed data (m = 50 imputations). *P £.05; **P £.01; ***P £.001.

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respondents reported police intrusion levels predictive of PTSD symptoms is troubling.

The associations between reported stop experience and mental health were robust to missing data analysis strategy, with findings substantively similar in both the multiply im- puted and complete case samples. However, in the complete case sample, the relationship between respondent perceptions of global procedural justice and anxiety, statistically sig- nificant in the imputed models, was stronger in magnitude but lost statistical significance. In addition, in the PTSD model considering stop conduct in the context of procedural justice, the number of total stops respondents reported experiencing was statistically insignificant in the complete case estimate (although similar in magnitude to the imputed estimate).

We note sensitivity to sample weighting through several small differences in our weighted and unweighted model results. The

association between anxiety and stop intrusion in model 2 was only marginally significant in the weighted sample (although the magnitude remained comparable). In both samples, the association increased in magnitude but lost further significance in model 3, considering the context of procedural justice. In both samples, respondents perceiving greater global proce- dural justice (but not critical stop procedural justice) reported reduced anxiety symptoms; procedural justice was also associated with a slight but insignificant reduction of the link between anxiety and intrusion.

Examining PTSD in the weighted sample, findings also diverged slightly—in models 1 and 2 the selection parameter was much larger in magnitude and at least marginally significant, suggesting that respondents at greatest risk for being stopped at least once were also at the greatest risk for PTSD from these stops. Finally, race/ethnicity coefficients were larger and

statistically significant in the weighted sample, suggesting higher PTSD prevalence among Black respondents.

It is notable, however, that despite these differences, the substantive associations be- tween respondents’ experiences with the police and their mental health were strong and largely robust across samples and models—particularly among respondents reporting stops carried out in an intrusive fashion. This raises concerns that the aggressive nature of proactive policing may have implications not only for police---community relations but also for local public health. In fact, the significant associations between both health outcomes and respondent perceptions of procedural justice suggest that police--- community relations and local public health are inextricably linked.

Limitations

Our analysis, particularly our collection of population-based data, represents significant progress toward understanding the implica- tions of policing for population health. How- ever, our findings must be interpreted with caution. First, our conclusions are limited by the cross-sectional nature of our data, and we make no causal claims. In fact, causal direction is uncertain. For example, it is possible that men’s mental health influenced their percep- tions of their interactions and that those facing the greatest anxiety and stress tended to exag- gerate their experiences.

Likewise, respondents displaying mental health symptoms might have attracted greater reasonable suspicion or responded to police questioning in ways that escalated their situa- tions. The statistically significant relationships between anxiety, criminal involvement, and stop experience further underscore the com- plexity of relationships linking police activity and its correlates. However, the strong associa- tions between police conduct and population health raise serious concerns about potential unintended consequences of police activity, suggesting a need for longitudinal research disentangling the causal nature of these associations.

Our conclusions are also circumscribed by somewhat low reliability of 2 key measures (police intrusion and criminal activity, a = .68 and .61, respectively) and challenges in sam- pling young urban men, generally understood

TABLE 3—Estimated Predictors of PTSD Symptoms (IES–R) Ordinary Least Squares

Parameter Estimates and SEs: Survey of Associations Between Police Contact and Mental

Health, New York City, September 2012–March 2013

Variable Model 1, b (SE) Model 2, b (SE) Model 3, b (SE)

Stops

Total lifetime 0.03*** (0.01) 0.02*** (0.01) 0.01* (0.01)

Intrusion 0.33*** (0.05) 0.21** (0.10)

Procedural justice

Global 0.03 (0.04)

Critical stop –0.09*** (0.02)

Global · intrusion –0.02* (0.01) Critical · intrusion 0.01* (0.01)

Selection parameter, IPT –0.27 (0.39) 0.06 (0.36) 0.34 (0.35)

Race/ethnicity

Black 0.61 (0.38) 0.51 (0.36) 0.21 (0.32)

Hispanic –0.08 (0.32) –0.15 (0.31) –0.12 (0.29)

Other or unknown 0.31 (0.43) –0.01 (0.41) –0.26 (0.40)

Education

< high school 0.35 (0.42) 0.06 (0.41) –0.08 (0.38)

Some college or technical school 0.04 (0.26) 0.06 (0.25) –0.06 (0.23)

College graduate 0.17 (0.31) 0.32 (0.29) 0.14 (0.27)

Self-reported criminal activity 0.37 (0.21) 0.36 (0.19) 0.38* (0.18)

Public housing 0.91* (0.38) 0.73* (0.36) 0.69* (0.32)

Neighborhood FE included, yes or no Yes Yes Yes

Number of observations per imputation 547 547 547

Note. FE = fixed effects; IES–R = Impact of Event Scale–Revised; IPT = inverse probability of treatment; PTSD = posttraumatic stress disorder. Analyses are derived from multiply imputed data (m = 50 imputations). We measured PTSD only for respondents stopped once or more in the year leading up to the survey. *P £.05; **P £.01; ***P £.001.

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to be a hard-to-reach population. Although our population-based sampling procedures are in- novative, our cooperation rate of 52% suggests that many young men eligible for our survey declined to participate. Although this is to be expected because of the sensitive nature of police contact, our respondents reported sig- nificantly more contact with the police than expected in a random sample of young men in New York City.

We observed higher than average contact rates across races/ethnicities, with and without weighting to reflect the oversampling of high- stop neighborhoods. It is likely that young men without police experience had less interest in the study and were less likely to participate, and our participants’ stop experiences there- fore cannot be assumed to generalize citywide. Nonetheless, the links between police intrusion and mental health, observed in a population- based sample reporting high rates of contact, raise public health concerns for the individuals and communities most aggressively targeted by the police.

Implications

The contentious policy debate around stop and frisk in New York City has largely focused on whether aggressive police scrutiny

is a justifiable approach to crime detection and deterrence20,21—or whether disparities in offending justify racial/ethnic disparities in policing.16,43 Another debate focuses on the constitutionality of stop and frisk tactics with respect to racial/ethnic discrimination11,17 and suspicionless stops and searches.11 Notwith- standing the dearth of evidence to justify a crime-control claim, and the constitutional concerns these arguments raise, our findings suggest that any benefits achieved by aggres- sive proactive policing tactics may be offset by serious costs to individual and community health.

Although more work is needed to fully understand these associations, our findings are consistent with a growing literature identifying criminal justice practices as a threat to physical and mental health. Moreover, our findings suggest that these risks are not limited to individuals formally processed through an ar- rest or incarceration. Rather, the low levels of contact that many urban residents face on a regular basis—without formal sanctions—risk serious adverse consequences. j

About the Authors At the time of the study, Amanda Geller was with the Department of Sociomedical Sciences, Mailman School of

Public Health, Columbia University, New York, NY. Jeffrey Fagan is with Columbia Law School, Columbia University. Tom Tyler is with Yale Law School, Yale University, New Haven, CT. Bruce G. Link is with the Department of Epidemiology, Mailman School of Public Health. Correspondence should be sent to Amanda Geller,

NYU Department of Sociology, New York, NY 10012 (email: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted April 9, 2014.

Contributors A. Geller contributed to the development of the sampling plan and the survey, conducted the analyses, and led the writing. J. Fagan and T. Tyler contributed to the conceptualization of the study and the development of the sampling plan, survey, and analysis. B. G. Link contributed to the development of the measures and the survey. All authors contributed to the writing of the article.

Acknowledgments This research was supported by the Public Health Law Research Program of the Robert Wood Johnson Foundation (grant 69669) and the National Institute of Justice (grant 2010-IJ-CX-0025). Additional support was provided by the National Institute of Child Health and Human Development (award R24HD058486).

Chintan Turakhia, Dean Williams, Marci Schalk, and Courtney Kennedy at Abt SRBI led outstanding survey operations. Julien Teitler provided important support in the early stages of the research. Chelsea Davis provided invaluable research assistance.

Human Participant Protection The institutional review boards at Columbia University, Yale University, and SRBI approved this study.

0

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te d

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SI )

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a b

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Note. BSI = Brief Symptom Inventory. Scatterplots and lowess smoothed lines are derived from predicted anxiety and PTSD symptoms as a function of stop intrusion, adjusted for race/ethnicity,

education, public housing residence, criminal involvement, lifetime stop experience, and perceived procedural justice. Bandwidth = 0.8.

FIGURE 1—Mental health outcomes by stop intrusion for (a) anxiety and (b) posttraumatic stress disorder (PTSD): Survey of Associations

Between Police Contact and Mental Health, New York City, September 2012–March 2013.

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