Surveillance, Violence, and Assistance: Distinct Typologies of Police Contact and Prospective Health Outcomes Among People Who Use Drugs
- 1Department of Epidemiology, New York University School of Global Public Health, New York, New York, United States
- 2Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Abstract
Policing is increasingly understood as a structural determinant of health, yet the social epidemiology of police contact remains limited by limitations to variable-centered measurement which may not capture the complexity of exposure. We aim to address this gap in a cohort of people who use drugs, a population facing disproportionate and consequential police contact, using person-centered methods to examine qualitatively distinct exposure profiles. We applied latent class analysis to 11 police contact indicators among a longitudinal cohort of people who use drugs in Baltimore, Maryland (N = 486) and estimated associations between baseline police-contact class and health outcomes at 6-month follow-up using BCH-weighted logistic regression with cluster-robust standard errors. We identified three classes: minimal contact (64%), routine enforcement (25%), and violent enforcement (11%), the latter characterized by high surveillance alongside violence, coercion, and paradoxically, police assistance. After adjustment, those in the violent enforcement class had increased odds of nonfatal overdose at follow-up (aOR 3.23, 95% CI 1.78-5.87), while those in the routine enforcement class had higher odds of injection drug use (aOR 2.85, 95% CI 1.56-5.23) and lower odds of HIV testing (aOR 0.58, 95% CI 0.39-0.85). These findings demonstrate that police contact comprises qualitatively distinct typologies associated with distinct downstream health consequences among people who use drugs, and point to a need for longitudinal research to elucidate the mechanisms through which each operates. Implications of the co-occurrence of severe enforcement and police assistance among the most impacted individuals for reforms which aim to mitigate harmful police contact on population health are discussed.
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BibTeX
@article{rouhani2026surveillance,
title = {{Surveillance, Violence, and Assistance: Distinct Typologies of Police Contact and Prospective Health Outcomes Among People Who Use Drugs}},
author = {Saba Rouhani and Mehrdad Khezri and Kristin E. Schneider and Catherine A. Tomko and Laura N. Sisson and Emily M. Martin and Danielle F. Nestadt and Susan G. Sherman},
journal = {Social science \& medicine (1982)},
year = {2026},
month = sep,
doi = {10.1016/j.socscimed.2026.119841},
url = {https://doi.org/10.1016/j.socscimed.2026.119841},
note = {CC BY},
}
RIS
TY - JOUR
TI - Surveillance, Violence, and Assistance: Distinct Typologies of Police Contact and Prospective Health Outcomes Among People Who Use Drugs
AU - Saba Rouhani
AU - Mehrdad Khezri
AU - Kristin E. Schneider
AU - Catherine A. Tomko
AU - Laura N. Sisson
AU - Emily M. Martin
AU - Danielle F. Nestadt
AU - Susan G. Sherman
PY - 2026
DA - 2026/09/19
JO - Social science & medicine (1982)
DO - 10.1016/j.socscimed.2026.119841
UR - https://doi.org/10.1016/j.socscimed.2026.119841
AB - Policing is increasingly understood as a structural determinant of health, yet the social epidemiology of police contact remains limited by limitations to variable-centered measurement which may not capture the complexity of exposure. We aim to address this gap in a cohort of people who use drugs, a population facing disproportionate and consequential police contact, using person-centered methods to examine qualitatively distinct exposure profiles. We applied latent class analysis to 11 police contact indicators among a longitudinal cohort of people who use drugs in Baltimore, Maryland (N = 486) and estimated associations between baseline police-contact class and health outcomes at 6-month follow-up using BCH-weighted logistic regression with cluster-robust standard errors. We identified three classes: minimal contact (64%), routine enforcement (25%), and violent enforcement (11%), the latter characterized by high surveillance alongside violence, coercion, and paradoxically, police assistance. After adjustment, those in the violent enforcement class had increased odds of nonfatal overdose at follow-up (aOR 3.23, 95% CI 1.78-5.87), while those in the routine enforcement class had higher odds of injection drug use (aOR 2.85, 95% CI 1.56-5.23) and lower odds of HIV testing (aOR 0.58, 95% CI 0.39-0.85). These findings demonstrate that police contact comprises qualitatively distinct typologies associated with distinct downstream health consequences among people who use drugs, and point to a need for longitudinal research to elucidate the mechanisms through which each operates. Implications of the co-occurrence of severe enforcement and police assistance among the most impacted individuals for reforms which aim to mitigate harmful police contact on population health are discussed.
SN - 0277-9536
SN - 1873-5347
ER -