Population Research and Policy Review

, Volume 38, Issue 2, pp 271–299 | Cite as

Beyond Race/Ethnicity: Skin Color, Gender, and the Health of Young Adults in the United States

  • Krista M. PerreiraEmail author
  • Joshua Wassink
  • Kathleen Mullan Harris
Original Research


Researchers typically identify health disparities using self-reported race/ethnicity, a measure identifying individuals’ social and cultural affiliations. In this study, we use data from Waves 1, 3, and 4 of Add Health to examine health disparities by interviewer-ascribed skin color, a measure capturing the perceptions of race/ethnicity ascribed to individuals by others. Individuals with darker-skin tones may face greater exposure to serious stressors such as perceived discrimination, poverty, and economic hardship which can accumulate over the lifecourse and increase the likelihood of poor health. We found significant gradients in Body Mass Index (BMI), obesity, self-reported health, and depressive symptoms by interviewer-ascribed skin color but results differed by gender. Associations of BMI, obesity, and fair/poor health among women were only partially mediated by discrimination, self-reported stress, or low socioeconomic status and persisted after controlling for race/ethnicity. Among men, initial associations between skin color and both fair/poor health and depressive symptoms did not persist after controlling for race/ethnicity. This study demonstrates the value of considering stratification by skin color and gender in conjunction with race/ethnicity.


Skin color/tone Race/ethnicity Hispanic Black Health disparities/equity Discrimination 



We would like to thank the UNC Gillings School of Global Public Health for providing the primary funding to Krista M. Perreira for this research project. We are also grateful to the Carolina Population Center for training support (T32 HD007168) and for general support (R24 HD050924) of this research. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Information on how to obtain the Add Health data files is available on the Add Health website (


  1. Adler, N. E., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60–76.Google Scholar
  2. Alba, R., Insolera, N., & Lindeman, S. (2016). Comment: Is race really so fluid? Revisiting Saperstein and Penner’s empirical claims. American Journal of Sociology, 122(1), 247–262.Google Scholar
  3. Aneshensel, C. S. (1996). Consequences of psychosocial stress: The Universe of stress outcomes. In H. B. Kaplan (Ed.), Psychosocial stress: Perspectives on structure, theory, life course and methods (pp. 111–136). CA: Academic Press, San Diego.Google Scholar
  4. Armstead, C. A., Hébert, J. R., Griffin, E. K., & Prince, G. M. (2014). A question of color: The influence of skin color and stress on resting blood pressure and body mass among African American women. Journal of Black Psychology, 40(5), 424–450.Google Scholar
  5. Bonilla-Silva, E. (1997). Rethinking racism: Toward a structural interpretation. American Sociological Review, 62(3), 465.Google Scholar
  6. Bonilla-Silva, E. (2004). From bi-racial to tri-racial: Towards a new system of racial stratification in the USA. Ethnic and Racial Studies, 27(6), 931–950.Google Scholar
  7. Borrell, L. N., Kiefe, C. I., Williams, D. R., Diez-Roux, A. V., & Gordon-Larsen, P. (2006). Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Social Science and Medicine, 63(6), 1415–1427.Google Scholar
  8. Bratter, J. L., & Gorman, B. K. (2011). Does multiracial matter? A study of racial disparities in self-rated health. Demography, 48(1), 127–152.Google Scholar
  9. Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Supplement 3), S163–S175.Google Scholar
  10. Brown, J. Scott, Hitlin, S., & Elder, G. H. (2006). The greater complexity of lived race: An extension of Harris and Sim. Social Science Quarterly, 87(2), 411–431.Google Scholar
  11. Browne, I., & Misra, J. (2003). The intersection of gender and race in the labor market. Annual Review of Sociology, 29, 487–513.Google Scholar
  12. Brownstein, N., et al. (2010). Non-response in wave IV of the national longitudinal study of adolescent health. Retrieved from (
  13. Campbell, M. E., & Troyer, L. (2007). The implications of racial misclassification by observers. American Sociological Review, 72(5), 750–765.Google Scholar
  14. Chantala, K., & Tabor, J. (1999). Strategies to perform a design-based analysis using the add health data. Carolina Population Center, University of North Carolina at Chapel Hill. Retrieved (
  15. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.Google Scholar
  16. Cummings, J. L., & Jackson, P. (2008). Race, gender, and SES disparities in self-assessed health, 1974–2004. Research on Aging, 30(2), 137–167.Google Scholar
  17. Dixon, A. R., & Telles, E. E. (2017). Skin color and colorism: global research, concepts, and measurement. Annual Review of Sociology, 43, 405–424.Google Scholar
  18. Doyle, J. M., & Kao, G. (2007). Are Racial identities of multiracials stable? Changing self-identification among single and multiple race individuals. Social Psychology Quarterly, 70(4), 405–423.Google Scholar
  19. Drake, S., & Cayton, H. (1945). Black metropolis. New York: Harcourt Brace.Google Scholar
  20. Dressler, W. W., Oths, K. S., & Gravlee, C. C. (2005). Race and ethnicity in public health research: Models to explain health disparities. Annual Review of Anthropology, 34(1), 231–252.Google Scholar
  21. Flegal, K., et al. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA, 307(5), 491–497.Google Scholar
  22. Frank, R., Akresh, I. R., & Bo, L. (2010). Latino immigrants and the U.S. racial order: How and where do they fit in? American Sociological Review, 75(3), 378–401.Google Scholar
  23. Fuligni, A. J., Kiang, L., Witkow, M. R., & Baldelomar, O. (2008). Stability and change in ethnic labeling among adolescents from Asian and Latin American immigrant families. Child Development, 79(4), 944–956.Google Scholar
  24. Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). ‘Weathering’ and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health, 96(5), 826–833.Google Scholar
  25. Golash-Boza, T., & Darity, W. (2008). Latino racial choices: The effects of skin colour and discrimination on latinos’ and latinas’ racial self-identifications. Ethnic and Racial Studies, 31(5), 899–934.Google Scholar
  26. Gravlee, C. C., Dressler, W. W., & Russell Bernard, H. (2005). Skin color, social classification, and blood pressure in Southeastern Puerto Rico. American Journal of Public Health, 95(12), 2191–2197.Google Scholar
  27. Hagiwara, N., Kashy, D. A., & Cesario, J. (2012). The independent effects of skin tone and facial features on Whites’ affective reactions to Blacks. Journal of Experimental Social Psychology, 48(4), 892–898.Google Scholar
  28. Harris, A. (2009). Introduction: Economies of color. In E. Glenn (Ed.), Shades of difference: Why skin color matters. Stanford, CA: Stanford University Press.Google Scholar
  29. Harris, K. M. (2013). Design features of add health. Carolina Population Center, UNC, 2011. Retrieved from
  30. Harris, D. R., & Sim, J. (2002). Who is multiracial? Assessing the complexity of lived race. American Sociological Review, 67(4), 614–627.Google Scholar
  31. Harter, S. (2000). Is self-esteem only skin-deep? The inextricable link between physical appearance and self-esteem. Reclaiming Children and Youth, 9(3), 133–138.Google Scholar
  32. Hayward, M. D., Miles, T. P., Crimmins, E. M., & Yang, Yu. (2000). The significance of socioeconomic status in explaining the racial gap in chronic health conditions. American Sociological Review, 65(6), 910.Google Scholar
  33. Herman, M. (2004). Forced to choose: Some determinants of racial identification in multiracial adolescents. Child Development, 75(3), 730–748.Google Scholar
  34. Hersch, J. (2011). The persistence of skin color discrimination for immigrants. Social Science Research, 40(5), 1337–1349.Google Scholar
  35. Hertzman, C., & Boyce, T. (2010). How experience gets under the skin to create gradients in developmental health. Annual Review of Public Health, 31, 329–347.Google Scholar
  36. Hilbe, J. M. (2011). Negative binomial regression. Cambridge, UK: Cambridge University Press.Google Scholar
  37. Hill, M. E. (2002). Race of the interviewer and perception of skin color: Evidence from the multi-city study of urban inequality. American Sociological Review, 67(1), 99–108.Google Scholar
  38. Hill, S. A. (2009). Cultural images and the health of African American women. Gender & Society, 23(6), 733–746.Google Scholar
  39. Hitlin, S., Scott Brown, J., & Elder, G. H. (2006). Racial self-categorization in adolescence: Multiracial development and social pathways. Child Development, 77(5), 1298–1308.Google Scholar
  40. Hunter, M. L. (2002). ‘If you’re light you’re alright’: Light Skin color as social capital for women of color. Gender & Society, 16(2), 175–193.Google Scholar
  41. Hunter, M. L. (2013). The consequences of colorism. In R. E. Hall (Ed.), The Melanin Millennium: Skin color as 21st century international discourse (pp. 247–256). New York: Springer.Google Scholar
  42. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.Google Scholar
  43. Jones, C. P., et al. (2008). Using ‘socially assigned race’ to Probe white advantages in health status. Ethnicity and Disease, 18(4), 496–504.Google Scholar
  44. Keith, V. M., & Herring, C. (1991). Skin tone and stratification in the black community. American Journal of Sociology, 97(3), 760–778.Google Scholar
  45. Keith, V. M., Lincoln, K. D., Taylor, R. J., & Jackson, J. S. (2010). Discriminatory experiences and depressive symptoms among African American women: Do skin tone and mastery matter? Sex Roles, 62(1–2), 48–59.Google Scholar
  46. Kiang, L., & Takeuchi, D. T. (2009). Phenotypic bias and ethnic identity in Filipino Americans. Social Science Quarterly, 90(2), 428–445.Google Scholar
  47. King, R. D., & Johnson, B. D. (2016). A punishing look: Skin tone and Afrocentric features in the halls of justice. American Journal of Sociology, 122(1), 90–124.Google Scholar
  48. Klonoff, E. A., & Landrine, H. (2000). Is skin color a marker for racial discrimination? Explaining the skin color-hypertension relationship. Journal of Behavioral Medicine, 23(4), 329–338.Google Scholar
  49. Kramer, R., DeFina, R., & Hannon, L. (2016). Racial rigidity in the United States: Comment on Saperstein and Penner. American Journal of Sociology, 122(1), 233–246.Google Scholar
  50. Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services: Planning, Administration, Evaluation, 29(2), 295–352.Google Scholar
  51. Krieger, N., Sidney, S., & Coakley, E. (1998). Racial discrimination and skin color in the CARDIA study: Implications for public health research. American Journal of Public Health, 88(9), 1308–1313.Google Scholar
  52. Link, B., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94.Google Scholar
  53. Manor, O., Matthews, S., & Power, C. (2000). Dichotomous or categorical response? Analyzing self-rated health and lifetime social class. International Journal of Epidemiology, 29(1), 149–157.Google Scholar
  54. Mays, V., Ponce, N., Washington, D., & Cochran, S. (2003). classification of race and ethnicity: Implications for public health. Annual Review of Public Health, 24, 83–110.Google Scholar
  55. Monk, E. P., Jr. (2014). Skin tone stratification among Black Americans, 2001–2003. Social Forces, 92(4), 1313–1337.Google Scholar
  56. Monk, E. P., Jr. (2015). The cost of color: Skin color, discrimination, and health among African-Americans. American Journal of Sociology, 121(2), 396–444.Google Scholar
  57. Montalvo, F., & Edward Codina, G. (2001). Skin color and Latinos in the United States. Ethnicities, 1(3), 321–341.Google Scholar
  58. Nagel, J. (1994). Constructing ethnicity: Creating and recreating ethnic identity and culture. Social Problems, 41(1), 152–176.Google Scholar
  59. National Center for Health Statistics (NCHS). (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. MD: Hyattsville.Google Scholar
  60. Painter, M., Holmes, M., & Bateman, J. (2015). Skin tone, race/ethnicity, and wealth inequality among new immigrants. Social Forces, 94(3), 1153–1185.Google Scholar
  61. Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35(4), 888–901.Google Scholar
  62. Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554.Google Scholar
  63. Pearlin, L., Schieman, S., Fazio, E., & Meersman, S. (2005). Stress, health, and the life course: Some conceptual perspectives. Journal of Health and Social Behavior, 46(2), 205–219.Google Scholar
  64. Perreira, K. M., Deeb-Sossa, N., Harris, K. M., & Bollen, K. (2005). What Are we measuring? An evaluation of the CES-D across race/ethnicity and immigrant generation. Social Forces, 83(4), 1567–1601.Google Scholar
  65. Perreira, K. M., & Telles, E. E. (2014). The color of health: Skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Social Science and Medicine, 116, 241–250.Google Scholar
  66. Phelan, J. C., Link, B., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(1 suppl), S28–S40.Google Scholar
  67. Phinney, J. S. (1996). Understanding ethnic diversity: The role of ethnic identity. American Behavioral Scientist, 40(2), 143–152.Google Scholar
  68. Pratt, L., & Brody, D. J. (2014). Depression in the U.S. household population, 2009–2012. NCHS Data Brief 127. Retrieved from
  69. Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.Google Scholar
  70. Rockquemore, K. A., & Brunsma, D. L. (2002). Socially embedded identities: Theories, typologies, and processes of racial identity among black/white biracials. The Sociological Quarterly, 43(3), 335–356.Google Scholar
  71. Rosenfield, S., & Mouzon, D. M. (2013). Gender and mental health. In C. S. Aneshensel & J. C. Phelan (Eds.), Handbook of the sociology of mental health. New York: Springer.Google Scholar
  72. Ryabov, I. (2013). Colorism and school-to-work and school-to-college transitions of African American adolescents. Race and Social Problems, 5(1), 15–27.Google Scholar
  73. Saperstein, A., & Penner, A. M. (2012). Racial fluidity and inequality in the United States. American Journal of Sociology, 118(3), 676–727.Google Scholar
  74. Saperstein, A., & Penner, A. M. (2014). Beyond the looking glass: Exploring fluidity in racial self-identification and interviewer classification. Sociological Perspectives, 57(2), 186–207.Google Scholar
  75. Schulz, A. J., & Mullings, L. (2006). Gender, race, class, and health: Intersectional approaches. San Francisco, CA: Jossey-Bass.Google Scholar
  76. Smedley, B. D., Stith, A. Y., Nelson, A. R., & Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine.Google Scholar
  77. Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology (pp. 290–313). San Francisco: Jossey-Bass.Google Scholar
  78. Thoits, P. A. (2010). Stress and health major findings and policy implications. Journal of Health and Social Behavior, 51(1 suppl), S41–S53.Google Scholar
  79. Tichenor, D. J. (2009). Dividing lines: The politics of immigration control in America. Princton, NJ: Princeton University Press.Google Scholar
  80. Vaquera, E., & Kao, G. (2006). The implications of choosing ‘no race’ on the salience of hispanic identity: How racial and ethnic backgrounds intersect among hispanic adolescents. Sociological Quarterly, 47(3), 375–396.Google Scholar
  81. Wassink, J., Perreira, K. M., & Harris, K. M. (2017). Beyond race/ethnicity: Skin color and cardiometabolic health among blacks and hispanics in the United States. Journal of Immigrant and Minority Health, 19(5), 1018–1026.Google Scholar
  82. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.Google Scholar
  83. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socioeconomic status, stress, and discrimination. Journal of Health Psychology, 2(3), 335–351.Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Krista M. Perreira
    • 1
    • 2
    Email author
  • Joshua Wassink
    • 3
  • Kathleen Mullan Harris
    • 1
  1. 1.University of North CarolinaChapel HillUSA
  2. 2.Carolina Population Center (CB#8120)Chapel HillUSA
  3. 3.Office of Population ResearchPrinceton UniversityPrincetonUSA

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