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Harvard Journal of African American Policy

Topic / Gender, Race and Identity

Race, Place and Police: The 2009 Shooting of Oscar Grant

Featured - Race place and police

Abstract

Early on New Year’s Day in 2009, a police officer investigating a disturbance at the Fruitvale BART (Bay Area Rapid Transit) Station in Oakland, California, shot and killed Oscar Grant. The officer was White, and Grant was Black. At every stage of the process that followed, Bay Area residents responded with protests, some engaging in property destruction. This article presents an analysis of those events as well as policy recommendations for addressing the issues identified.

Introduction: Race and Police in Oakland, California

Oakland’s population boomed in the early part of the twentieth century as shipbuilders took over the East Bay front. Two Bay Area impresarios, Kaiser and Moore, sought laborers for their shipyards, which boomed during World War II.[i],[ii] Looking for people who “knew how to work,”[iii] they recruited Black sharecroppers from the Deep South. They also sought law enforcement who “knew how to deal with those people,” drawing from police forces in the Jim Crow South.[iv] These racial dynamics persisted over decades in the relationship between Oakland’s police force and its Black community. They set the stage for the explosive reaction to the January 2009 shooting of young Black Oscar Grant by a White police officer.

The Incident: Oscar Grant’s Death and Aftermath

Shortly after the Bay Area welcomed the new year in 2009, Bay Area Rapid Transit (BART) police arrived at Fruitvale Station in Oakland, responding to reports of fighting. Among the men taken from the train was Oscar Grant III. According to SFGate, “as [Officer Johannes Mehserle] moved to cuff him . . . Grant violently pulled his right hand away,” perhaps “[reacting] to abusive words from [another officer].”[v] The abusive words came from Mehserle’s partner Tony Pirone, who called Grant a “bitch ass nigger,” although it is unclear whether Pirone or Grant said these words first.[vi] Thinking Grant might have been reaching for a gun, Mehserle pulled out a weapon and shot Grant in the back. In reality, Grant, a twenty-two-year-old Black male, was unarmed.

Public outrage arose following the shooting, stoked by YouTube videos of the incident posted by witnesses. Days later, “hundreds of protestors rampaged through the streets of downtown Oakland, creating a near-riot that lasted for several hours.”[vii] The aftermath included “protestors [laying] prone in front of police, hands behind their backs, saying, ‘I am Oscar Grant.’”[viii] The New York Times reported, “civic leaders said . . . that the violence reflected anger among young people—and particularly young Black men—who feel that they are unfair targets of the police.”[ix]

The components of the incident’s aftermath can be loosely characterized by three themes: (1) prosecutorial aggression, (2) judicial intervention and independence, and (3) responsive public outcry. Nearly two weeks after the shooting, Mehserle was charged. After initially charging Mehserle with first-degree murder, the judge ultimately ruled that the most severe charge possible would be second-degree murder. Protests continued, beginning with a “largely peaceful rally of more than 1,000” but also “demonstrators [who] began a rampage through downtown, smashing windows at a dozen businesses, vandalizing several cars and forcing police . . . to spray tear gas.”[x]

The bail hearing provided another opportunity for judicial intervention and independence. More than two weeks after the indictment, bail was set at $3 million for Mehserle, causing “thousands of residents [to gather] to voice their outrage . . . and to demand that Mehserle not be given a chance to leave jail on bail.”[xi] On Friday, 6 February 2009, Mehserle posted bail and was released.

The trial components included several key moments of judicial intervention, many of which led to public outcry. Mehserle’s preliminary hearing began on 18 May 2009, against the backdrop of protests. In advance of the trial, the defense outlined its intention to bring Grant’s past encounters with law enforcement into its arguments. John Burris, an attorney for Grant’s family, labeled such tactics as character assassination. Also crucial to the defense’s argument was the notion that Mehserle meant to use his Taser on Grant. The prosecution asserted that the shooting was intentional, following a contentious interaction that featured racial language directed at Grant. Also of note, the trial was relocated to Los Angeles “because of pretrial publicity and the threat of violence.” [xii] The Los Angeles jury did not include any Black members.

Ultimately, the jury found Mehserle guilty of involuntary manslaughter. Following the verdict, the Grant family’s attorney asserted, “’the system is rarely fair when a police officer shoots an African-American male.’”[xiii] That evening, more than 1,000 people rioted in Oakland. According to the San Jose Mercury News, “wearing black masks, many looted stores, smashed windows and rolled trash bins into the streets while setting them on fire.”[xiv]

In the end, Los Angeles Superior Court Judge Robert Perry reduced Mehserle’s potential prison sentence down to four years and ultimately sentenced him to two years (of which he served only eleven months). Protests followed both Mehserle’s sentencing and early release, with Grant’s uncle asserting, “I do believe it’s a racist criminal justice system.”[xv]

History: Black Cultural Center, Contested

Oakland as a Center of Black Culture

Oakland has a long history as a center of Black culture that “shaped Black identity for the nation.”[xvi] Over time, it came to be known as “the Harlem of the West.” In the 1920s, the Brotherhood of Sleeping Car Porters, headquartered in Oakland, became the first Black union to be recognized by the AFL. In the 1940s and 1950s, Oakland was a hub of blues and jazz culture. In the 1960s, the Black Panther Party was founded in Oakland, and in the 1980s, the Black population rose to almost 50 percent of the population,[xvii] representing almost 35 percent of the Bay Area’s total Black population.[xviii] In the 1990s, Oakland became a center for hip-hop culture; Tupac Shakur called the city home. Oakland looms in the national Black consciousness, and as such, it is an incendiary place for incidents of perceived racist violence.

Notably, the Black population in Oakland has declined over the past thirty years.[xix] It is now more multiethnic, with Whites, Blacks, Asians, and Latinos sharing the city.

Police Brutality and the Black Panthers

Police brutality was a central issue for the Black Panther Party, which was founded in and was active in Oakland. Huey Newton, a cofounder of the Party, once said, “The key plank of the Panther platform . . . was a non-negotiable demand for the immediate end of police harassment and brutality in the Black community.”[xx] Bobby Seale, the other cofounder, similarly spoke about “these racist dog swine who been controlling our community and occupying our community like a foreign troop.”[xxi]

The Black Panthers would conduct “police patrols,” in which they would observe and document police action, inform arrestees of their constitutional rights, and carry law books. They would also open carry weapons to intimidate police and provoke confrontations to win the sympathy of Black audiences. Thus, the narrative of police abuse that surfaced in the Oscar Grant incident has existed for decades in Oakland, and the process of documenting abuses by police—seen in the taking of amateur YouTube videos—has historical roots as well.

Bobby Hutton

Bobby Hutton was sixteen when he joined the Black Panther Party. Two years later, police ambushed a group of Panthers, and a shootout followed. After their surrender, Hutton was shot twelve times and stripped to his underwear. The incident provoked major discontent in the Black community and “set a tone of discord between the OPD [Oakland Police Department] and . . . the city’s Black community that has lasted until the present day.”[xxii]

The Rough Riders

In the 1990s, a group of four OPD officers, led by Francisco “Choker” Vazquez, called themselves the Rough Riders and were accused of planting evidence, brutalizing suspects, falsifying reports, and framing innocent people. Most of their victims were former convicts, many of whom were minorities; few questioned the legitimacy of police action against them.

The Riders had been active for a decade when a twenty-three-year-old recruit turned them in to the internal investigation department of the police force, as he felt pressure to comply with their methods. Three of the Riders were arrested, and Vazquez fled—likely to Mexico—and has still not been found. Lawsuits against the OPD ensued, filed by 119 plaintiffs who won a total of $10.9 million.[xxiii] Charges were brought against the Riders, but a jury with no Black members acquitted them of eight charges and reached no verdict on twenty-seven.[xxiv] The OPD was seen to have acted with impunity (particularly against the Black community) in a systematically brutal and unjust way.

After the 2003 trial, the OPD was placed under external oversight by a district judge, who mandated fifty-one reforms to be instituted by 2008. The deadline was extended three times, and the cost of compliance rose above $15 million.[xxv] To this day, the OPD still has nine reforms outstanding.[xxvi] Thus, it was acknowledged by both society and the judiciary that OPD had a problem with police brutality—and that it has not been resolved even today.

Chauncey Bailey

The audit of the investigation of the Chauncey Bailey murder similarly revealed the shortcomings of the OPD and incensed the Black community. In 2007, Chauncey Bailey, a famous Black journalist, was assassinated on the street in Oakland in broad daylight. He had been investigating Your Black Muslim Bakery, a local organization with a criminal past.

The murder became controversial not only because Chauncey was famous, but because a 2009 investigation of the 2007 murder case slammed Police Sergeant Derwin Longmire as someone who “probably didn’t belong in homicide” and who “neglected to do . . . just basic routine homicide 101.”[xxvii] Longmire was accused of having obstructed the investigation into suspect Yusuf Bey, with whom he had a personal relationship. He was also accused of allowing him special privileges while in custody.  This again undermined the legitimacy of the OPD and its relationship with the Black community.

Historical Data

Statistically speaking, the OPD has disproportionately targeted Blacks as a portion of the population over the last twenty years. According to our analysis of data taken from the OPD, 83 percent of victims of police shootings between 1993 and 2013 were Black. Blacks had declined, however, as a fraction of victims of police shootings at the time of the Oscar Grant shooting, from almost 95 percent in 1994 to only 58 percent in 2008. The absolute number of shooting victims had also declined from a high of twenty-three in 1995 to only seven in 2008.[xxviii] In other words, the Oscar Grant incident ironically came at a time when the problem it emblematized may have been improving.

Context: Oakland in 2009

Many of the issues in Oakland at the time of Grant’s death—poverty, community violence, and a fraught relationship between police and the community—existed prior to 2009, but new dynamics were also at play that influenced the public response. Specifically, the 2008 recession erased much of the economic progress that communities of color had made previously.

The 2010 census shows that Oakland was a multiracial city of 390,724 residents, upholding its legacy as a community of color with a mix of Latino (25 percent of population), Black (28 percent), and Asian American (17 percent) families.[xxix] The proportion of Black residents of Oakland had decreased from 35.9 percent, a loss of over 30,000 residents, since the 2000 Census.[xxx] Oakland retained the highest concentration of Black residents in the metropolitan Bay Area, which was less than 7 percent Black.[xxxi]

The relationship between police and the community continued to be challenging. The Oakland Citizens’ Police Review Board (CPRB) received ninety-six complaints against the OPD in 2009, a 23 percent increase from the year prior; Black males filed 48 percent of the complaints, Black females 21 percent.[xxxii] The CPRB sustained 7 percent of the complaints. BART Police did not file a report for 2009, but their 2010 audit provides a window into policing on transit. BART received sixty-six complaints; excessive use of force by officers was the primary allegation in fourteen of the cases. In 15 percent of the BART complaints, officers were deemed responsible for wrongdoing.[xxxiii] While it is difficult to understand the significance of these numbers without context, the low percentage of findings against officers in the OPD and BART likely contributed to the feeling that law enforcement was above accountability.

One major criticism and explanation for the antagonism between the OPD and the community is the dearth of officers residing in Oakland. In 2012, only 9 percent of officers lived in the community; most lived in surrounding suburbs. This dynamic contributes to Oakland residents seeing officers as outsiders, who don’t have Oakland’s interests at heart. Given Oakland’s racial makeup, sourcing officers from the community would allow for a police force whose demographics were more aligned with the community. Moreover, given that Oakland devotes 40 percent of its general fund to policing, suburban police residency is problematic for the local economy, as it sends a large portion of tax dollars into other communities.[xxxiv] California state law forbids residency requirements for city agencies, limiting Oakland’s options in retaining law enforcement as residents of the city.[xxxv]

The 2008 recession impacted households nationwide, with people of color experiencing disproportionate losses. White families experienced an 11 percent decrease in wealth, while Black and Latino families experienced a loss of 31 percent and 40 percent respectively.[xxxvi] Oakland did not fare as badly as many in California; between 2000 and 2009, median household income fell by 99.5 percent across California, while Oakland decreased of 65.9 percent.[xxxvii] Recessionary unemployment came faster and more markedly to Oakland than to other Bay Area communities, however; job losses began in July 2007, while San Francisco did not see losses until 18 months later. Employment recovery was slower and started later in Oakland as well.

In the years since 2009, gentrification has accelerated in the Bay Area, causing significant controversy about public transportation. Silicon Valley companies have developed their own networks of buses that obviate wealthier residents’ need to use BART. At the time of Grant’s death, this trend had not yet begun; the demographics and distribution of BART riders had remained largely consistent with research conducted ten years prior. The ethnic and socioeconomic makeup of BART ridership closely aligned with regional demographics. For example, Asian/Pacific Islanders made up 24 percent of the BART service area and were 24 percent of its ridership.[xxxviii]

The Problem: Police Brutality and Implicit Bias

The community interpreted the murder of Oscar Grant as an act of police brutality and the use of excessive force. Because Officer Mehserle was White and Oscar Grant was Black, many saw the murder as an incident of racial profiling, where excessive force was applied due to the irrational suspicion that Grant was a violent criminal.

Police brutality is the use of excessive or unnecessary force by police when dealing with civilians. “Excessive use of force” means force well beyond what would be necessary in order to handle a situation. Police brutality can also be coupled with racial profiling. In the United States, demonstrating racial profiling in court requires demonstrating explicit bias against a person because of their race. However, implicit bias also affects police officers’ decisions.

Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. These biases can include both positive and negative associations and are activated involuntarily. Everyone has implicit biases, they have real-world effects on our behavior, and they can be unlearned and replaced with new mental associations.

The Implicit Association Test (IAT) was designed in 1998 to measure the strength of implicit bias by measuring the relative strength of associations between pairs of concepts. The popular Black/White IAT analyzes the speed with which participants associate White and Black faces with positive and negative words. The racial group that individuals most quickly associate with positive terms reflects a positive implicit bias toward that group. Faster response times when pairing concepts indicate stronger associations. The Black/White IAT has been used in many studies and has shown a pro-White/anti-Black bias in most Americans, regardless of their own racial group.[xxxix],[xl] Moreover, researchers have documented this bias in children as young as six years old.[xli]

These implicit biases affect law enforcement decision making. Implicit bias may have affected Officer Mehserle’s shooting of Oscar Grant, because implicit bias can persist in individuals, including police officers, even when they consciously reject racial stereotypes. In fact, recent studies have studied implicit bias and the impact of race on the decision to shoot.[xlii]

Shooter/Weapons Bias

Researchers last May reviewed a decade of empirical evidence about police officers and implicit bias. They found that officers possess implicit bias that might make them more likely to shoot Black suspects than White ones. To test these disparities, researchers used video games to see how people reacted to suspects of different races. According to an article on Vox, “initial findings showed police officers generally did a good job of avoiding shooting unarmed targets of all races, but when shooting was warranted, officers pulled the trigger most quickly against Black suspects. This finding suggests that officers exhibit some racial bias in how quickly they pull the trigger.”[xliii]

Race and Perceptions of Crime

Multiple studies show that there is a strong perception that Black neighborhoods suffer from more crime than other neighborhoods, even when there is evidence to the contrary. A 2001 study examined the relationship between neighborhood racial composition and residents’ perceptions of their neighborhood’s level of crime. Using data from the late 1990s in Chicago, Baltimore, and Seattle, Lincoln Quillian and Devah Pager found a positive association between the percentage of young Black men in a neighborhood and perceived crime, even when controlling for a variety of neighborhood characteristics.[xliv] This suggests that stereotypes are influencing perceptions of neighborhood crime, so much so that these perceptions overwhelm any actual associations. This pervasive correlation between Blackness and perceived threat and between Blackness and perceived criminality may have played a role in the murder of Oscar Grant.

Issues Summary and Recommendations: Chipping Away at Structural Racism

Insights have emerged from research on the four major aspects of the Oscar Grant riots: the incident, its history, its context, and the problem. The following five recommendations for preventing further police brutality and racial profiling address each research area in turn. These suggestions would ideally be implemented in concert, not sequentially.

Reforms other than those contained here will be necessary to end violent incidents such as the death of Oscar Grant. Others might include full compliance with the requirements of OPD’s judicial oversight as well as efforts to address income and wealth inequality along racial lines.

Problem 1: The Divide Between Police in Oakland and the Community

OPD’s racial makeup and officers’ choices to live outside of Oakland contribute to the sense that OPD is an occupying force.[xlv] Given that California law prohibits residency requirements, a more comprehensive approach will be necessary.

OPD should implement a recruitment and training program (similar to the Army’s ROTC). The program would pay tuition and a stipend for graduates of Oakland public high schools to pursue a degree before joining the police force. These recruits would agree to serve on a local police force and remain in Oakland for a set number of years. This would increase the diversity of the historically White OPD and create closer ties between the police and the community they serve.

Problem 2: Lack of Justice in Incidents of Police Violence

There are two justice concerns at play in the shooting of Oscar Grant. The first is substantive: whether the justice system holds perpetrators accountable and repairs harm caused by the crime. The second concern is procedural: whether the community feels it has a voice in a meaningful process of determining the course of reconciliation.  Procedural justice is important to consider in situations that lead to civil unrest that may cause further violence.

Incidents of police violence are reviewed by an internal police board. Reports from OPD’s Independent Monitor suggest that internal review fails to properly disincentivize the use of force and live up to the goals of procedural justice.[xlvi] One way to deepen restorative and procedural justice is to ensure outside review for a broader range of police incidents. Given ongoing issues with internal review and justice concerns, OPD’s citizen review panel, appointed by the city council and independent of OPD, should have oversight over incidents currently subject only to internal review.

Problem 3: Implicit Bias

Research on implicit bias suggests that our subconscious associations are malleable through training.[xlvii],[xlviii] Programs exist in other jurisdictions to train agents to correct anti-Black/pro-White implicit bias.[xlix] We therefore recommend that police officers, judges, and jurists in Alameda County be trained to correct for implicit racial bias.

Problem 4: Fear-Based Decision Making

It is difficult for people to make decisions under conditions of fear that respect the lives of subjects and increase community safety. In high-stress situations, police officers are more likely to rely on instinct and stereotypes that may make them prone to use excessive force, especially against minorities.[l] We therefore recommend that officers involved in high-stress altercations have a cooling-off period of several hours before returning to active policing.

Problem 5: BART Is Hard to Police

Given the account of the police’s intervention and the shooting of Oscar Grant, it is apparent that BART is very difficult to police, especially during high-traffic times like New Year’s Eve. The station platforms are dimly lit, often crowded, and only staffed on a limited basis.

Crime prevention through environmental design is a method with substantial proven success.[li] Changes to the BART platform environment could make it easier to police. It is hard to know at this point which specific changes might be useful, but we recommend that BART commission a study on station design to make them safer for passengers and easier to police.

Acknowledgements
Special thanks to Reverend Sandhya Jha, MPP, founder of the Oakland Peace Center, for her invaluable input on the dynamics of race and place in Oakland.

Endnotes

[i] Sandhya Jha, interviewed by Katherine Blaisdell by phone, 24 November 2014.

[ii] Cuahutémoc Arroyo, “’Jim Crow’ Shipyards: Black Labor and Race Relations in East Bay Shipyards During World War II,” n.d.

[iii] Jha interview.

[iv] Ibid.

[v] Jaxon Van Derebeken, “Johannes Mehserle Says He Feared Oscar Grant Was Going for Gun,”oSFGate, 14 June 2014.

[vi] Aisha Harris, “How Accurate is Fruitvale Station?” Slate, 12 July 2013.

[vii] Eric Kurhi, Sean Maher, and Patrick May, “Protest Turns to Near-Riot as Hundreds Gather in Oakland to Decry BART Shooting,”rSan Jose Mercury News, 7 January 2009.

[viii] Jesse McKinley, “In California, Protests After Man Dies at Hands of Transit Police,” New York Times, 9 January 2009.

[ix] Ibid.

[x] Sandra Gonzales, “BART Cop Transported to Bay Area Jail, Charged with Murder,” San Jose Mercury News, 14 January 2009.

[xi] Paul Rosynsky, “Oakland Mayor Calls for Calm After Ex-BART Cop Gets Bail Set,” San Jose Mercury News, 30 January 2009.

[xii] Paul Rosynsky, “Los Angeles Judge Assigned to Mehserle Case,” Inside Bay Area, 2 December 2009.

[xiii] Demian Bulwa, “Mehserle Convicted of Involuntary Manslaughter,” SFGate, 9 July 2010.

[xiv] Cecily Burt, “Masked and Angry, Rioters Cause Chaos,” San Jose Mercury News, 9 July 2010.

[xv] Associated Press, “Protests Erupt in Oakland, Calif., After Ex-Transit Cop Sentenced,”rNBCNews, 6 November 2010.

[xvi] Matthai Kuruvila, “25% Drop in African American Population in Oakland,”ASFGate, 11 March 2011.

[xvii] Ibid.

[xviii] Bay Area Census, City of Oakland, 1970-1990.

[xix] Kuruvila, “25% drop in African American Population in Oakland.”

[xx] KPanther Patrols: Publicity and Performance. ‘It’s About Getting’ the Man’s Attention,’” The Black Panther, Black Community News Service. University of Virginia.

[xxi] Ibid.

[xxii] Paul Harris, “Oakland Police: Controversial History Sets Tone for City’s Discord,” Guardian, 26 October 2011.

[xxiii] Monica Cruz-Rosas, “Twelve Years After the Riders, A Long Legal Process Is Reaching Its Final Stage,”tOakland North, 20 October 2011.

[xxiv] Harris, “Oakland Police: Controversial History Sets Tone.”

[xxv] Cruz-Rosas, “Twelve Years After the Riders.”

[xxvi] United States District Court, Northern District of California. “Third Progress Report of the Compliance Director of the Oakland Police Department,”U25 August 2014.

[xxvii] Thomas Peele, “State Report Ripped Longmire for Bey Investigation,”tThe Chauncey Bailey Project, 20 October 2011.

[xxviii] Oakland Police Beat, “Steal Our Data!”

[xxix] United States Census Bureau, State and County Quick Facts: Oakland, California, 2010.

[xxx] Ibid.

[xxxi] Bay Area Census, San Francisco Bay Area, 2010.

[xxxii] City of Oakland. Citizens’ Police Review Board, Citizens’ Police Review Board 2009 Annual Report.

[xxxiii] BART Police Office of Internal Affairs, BART Police Internal Affairs 2010 Annual Report.

[xxxiv] Darwin Bond Graham, “The High Costs of Outsourcing Police,” East Bay Express, 8 August 2012.

[xxxv] Ibid.

[xxxvi] Signe-Mary McKernan, Caroline Ratcliffe, C. Eugene Steuerle, and Sisi Zhang, Impact of the Great Recession and Beyond: Disparities in Wealth Building by Generation and Race, Urban Institute, 22 April 2014.

[xxxvii] City-Data.com, Oakland, California Income Map, Earnings Map, and Wages Data.

[xxxviii] BART Marketing and Research Department, 2008 BART Station Profile Study.

[xxxix] John F. Dovidio, Samuel L. Gaertner, Kerry Kawakami, and Gordon Hodson, “Why Can’t We Just Get Along? Interpersonal Biases and Interracial Distrust,” Cultural Diversity and Ethnic Minority Psychology 8, no. 2 (May 2002): 88-102.

[xl] Anthony G. Greenwald et al., “Understanding and Using the Implicit Association Test,” Journal of Personality and Social Psychology 97, no. 1 (2009): 17-41.

[xli] Andrew Scott Baron and Mahzarin R. Banaji, “The Development of Implicit Attitudes: Evidence of Race Evaluations From Ages 6 to 10 and Adulthood,” Psychological Science 17, no. 1 (2006): 53-58.

[xlii] Cheryl Staats, State of the Science: Implicit Bias Review 2014, Kirwin Institute.

[xliii] German Lopez, “How Subconscious Racism Complicates Racial Disparities in Policing,” Vox, 2 March 2014.

[xliv] Lincoln Quillian and Devah Pager, “Black Neighbors, Higher Crime? The Role of Racial Stereotypes in Evaluations of Neighborhood Crime,”lAmerican Journal of Sociology 107, no. 3 (2001): 717-767.

[xlv] Jha interview.

[xlvi] Robert S. Warshaw, First Quarterly Report of the Independent Monitor for the Oakland Police Department, 22 April 2010.

[xlvii] Pamela M. Casey et al., Helping Courts Address Implicit Bias: Resources for Education, National Center for State Courts, 1 January 2012.

[xlviii] Chris Mooney, “The Science of Why Cops Shoot Young Black Men,” Mother Jones, 1 December 2014.

[xlix] Casey et al., Helping Courts Address Implicit Bias.

[l] Mooney, “The Science of Why Cops Shoot Young Black Men.”

[li] Carri Casteel and Corinne Peek-Asa, “Effectiveness of Crime Prevention Through Environmental Design (CPTED) in Reducing Robberies,”EAmerican Journal of Preventive Medicine 18, no. 4 (May 2000): 99-115.