Self-identified race, socially assigned skin tone, and adult physiological dysregulation: Assessing multiple dimensions of “race” in health disparities research

Abstract

Despite a general acceptance of “race” as a social, rather than biological construct in the social sciences, racial health disparities research has given less consideration to the dimensions of race that may be most important for shaping persistent disparities in adult physical health status. In this study, we incorporate the social constructionist view that race is multidimensional to evaluate the health significance of two measures of race, racial self-identification and the socially perceived skin tone of black Americans, in a sample of black and white adults in the Nashville Stress and Health Study (N=1186). First, we use the approach most common in disparities research—comparing group differences in an outcome—to consider self-identified racial differences in allostatic load (AL), a cumulative biological indicator of physical dysregulation. Second, we examine intragroup variations in AL among blacks by skin tone (i.e. light, brown, or dark skin). Third, we assess whether the magnitude of black-white disparities are equal across black skin tone subgroups. Consistent with prior research, we find significantly higher rates of dysregulation among blacks. However, our results also show that racial differences in AL vary by blacks’ skin tone; AL disparities are largest between whites and dark-skinned blacks and smallest between whites and light-skinned blacks. This study highlights the importance of blacks’ skin tone as a marker of socially-assigned race for shaping intragroup and intergroup variations in adult physiological dysregulation. These results demonstrate the importance of assessing multiple dimensions of race in disparities research, as this approach may better capture the various mechanisms by which “race” continues to shape health.

Perceived discrimination and health: Paradigms and prospects

“…While researchers have previously suggested feminine behaviors are linked to better health while masculine behaviors are linked to poorer health, Hart, Saperstein, Magliozzi, and Westbrook () demonstrated there may be a health penalty for cisgender individuals whose gender identities do not align with normative expectations of gender performance (men appearing more masculine and women appearing more feminine). Similarly, scholars have complicated dominant conceptualizations of race by examining skin tone in predicting subsequent health (Cobb, Thomas, Pirtle, & Darity, ; Cuevas, Dawson, & Williams, ; Monk, ). These findings push health scholars to complicate current measurements and conceptualizations of various identities, as many studies examining gender and racial differences in health conflate sex and gender and race and skin tone, respectively.…”

Socially-assigned race and health: a scoping review with global implications for population health equity

“…Perceived appearance, one's own subjective evaluation of their appearance, was used to capture socially-assigned race in two studies [32,37]. In another study, the interviewer's rating of skin tone was used as a marker of socially-assigned race for its "generalized perception of other" [13]. Lopez et al uses a slightly different approach to measure sociallyassigned (i.e., ascribed) race by querying respondents about self-perceived race, socially-ascribed race and…”

“…Only one study used a biomarker of physical health. Cobb et al [13] investigated whether interviewer observed sociallyassigned race was associated with allostatic load, as an indicator of physiologic dysregulation [13]. In the Cobb et al [13] study, the strength of the association between self-identified versus socially-assigned race was relatively equal, with socially-assigned race showing a slightly higher estimate.…”

“…There is a growing body of literature highlighting the need for a more thoughtful alignment with theoretical work emphasizing the multidimensionality of race [5,8,13,14]. Accounting for multiple dimensions of race describes the ways that race is socially constructed beyond self-identification and is dependent upon external perceptions and classification which shape how an individual is treated.…”

Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-5103

“…Race, when assessed in this fashion, is typically based on skin color and often neglects the genetic ancestry. 11 Recent studies suggest there is substantial admixture and misclassification of race in the United States when based on self-reported skin color. 12 Genetic ancestry can be accurately determined using well-characterized ancestry informative germline markers.…”