Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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


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.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Add Health Wave 5 is currently in the field and may be released in 2019–2020.

  2. 2.

    Among non-Hispanics in this sample, 151 adolescents reported White/Native American identities, 78 reported White/Asian identities, 86 reported White/Black race/ethnic identities, 20 reported Black/Asian identities, and 67 reported Black/Native American identities. In sensitivity analyses, we found that the associations between race/ethnicity and health did not depend on the racial/ethnic category to which multi-race individuals were assigned.

  3. 3.

    Previous studies have indicated that, interviewers perceive greater variation in skin tones within their own race/ethnicity than within another race/ethnicity (Hill 2002). To evaluate the association of race/ethnic matching of interviewers with respondents on interviewer-ascribed skin color, we estimated four separate ordered logistic regressions of skin color on interviewer’s race/ethnicity (White vs. non-White) among self-identified (1) White, (2) Asian, (3) Hispanic, and (4) Black respondents. Among White and Hispanic respondents, we found no evidence that the skin colors perceived by White interviewers differed from the skin colors perceived by non-white interviewers. However, among Black and Asian respondents, we found that White interviewers had higher odds of perceiving a darker skin color than non-White interviewers. We do not consider this result to be evidence of “bias” in interviewer-ascribed skin color since the aim of the Add Health questions was not to get an unbiased or objective measure of the respondent’s skin color. Instead, the aim was to identify how respondents would be perceived by others. Although interviewer race/ethnicity is correlated with interviewer-ascribed skin color, we have no reason to believe that interviewer race/ethnicity is correlated with a respondent’s health. A variable indicating that the interviewer was the same race as the respondents (1 = yes, 0 = no) in our models of health outcomes was never significant.

  4. 4.

    When parental income was added to the model, associations of young adult income and education with health remained unchanged.

  5. 5.

    Because of the high prevalence of obesity, odds ratios calculated from logistic models potentially overestimate the strength of associations and risk ratios calculated from binomial regressions are sometimes preferred. However, scholarship on the use of odds ratios versus risk ratios generally suggests that odds ratios become problematic when they fall outside the range of 0.5–2.5 (Hilbe 2011). Odd ratios for associations with obesity in this study fall below this range.

  6. 6.

    In additional analyses, we estimated multinomial logistic regressions of selecting a Black, Hispanic, or Asian versus a White racial/ethnic identity on skin color. We found strong positive associations between darker interviewer-assigned skin color and a non-White self-reported identity.

  7. 7.

    Regression analyses (available upon request) showed that skin color gradients in discrimination and stress did not differ by gender. Skin color gradients in income (Male βcolor = − 0.30 vs. Female βcolor = − 0.65. Wald test = 16.18, p < 0.001) and economic hardship (Male ORcolor = 0.05 vs. Female ORcolor = 0.13 Wald test = 9.98, p < 0.05) were significantly greater among women than among men.


  1. Adler, N. E., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60–76.

  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.

  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.

  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.

  5. Bonilla-Silva, E. (1997). Rethinking racism: Toward a structural interpretation. American Sociological Review, 62(3), 465.

  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.

  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.

  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.

  9. Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Supplement 3), S163–S175.

  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.

  11. Browne, I., & Misra, J. (2003). The intersection of gender and race in the labor market. Annual Review of Sociology, 29, 487–513.

  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.

  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.

  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.

  17. Dixon, A. R., & Telles, E. E. (2017). Skin color and colorism: global research, concepts, and measurement. Annual Review of Sociology, 43, 405–424.

  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.

  19. Drake, S., & Cayton, H. (1945). Black metropolis. New York: Harcourt Brace.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  28. Harris, A. (2009). Introduction: Economies of color. In E. Glenn (Ed.), Shades of difference: Why skin color matters. Stanford, CA: Stanford University Press.

  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.

  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.

  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.

  33. Herman, M. (2004). Forced to choose: Some determinants of racial identification in multiracial adolescents. Child Development, 75(3), 730–748.

  34. Hersch, J. (2011). The persistence of skin color discrimination for immigrants. Social Science Research, 40(5), 1337–1349.

  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.

  36. Hilbe, J. M. (2011). Negative binomial regression. Cambridge, UK: Cambridge University Press.

  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.

  38. Hill, S. A. (2009). Cultural images and the health of African American women. Gender & Society, 23(6), 733–746.

  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.

  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.

  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.

  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.

  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.

  44. Keith, V. M., & Herring, C. (1991). Skin tone and stratification in the black community. American Journal of Sociology, 97(3), 760–778.

  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.

  46. Kiang, L., & Takeuchi, D. T. (2009). Phenotypic bias and ethnic identity in Filipino Americans. Social Science Quarterly, 90(2), 428–445.

  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.

  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.

  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.

  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.

  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.

  52. Link, B., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94.

  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.

  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.

  55. Monk, E. P., Jr. (2014). Skin tone stratification among Black Americans, 2001–2003. Social Forces, 92(4), 1313–1337.

  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.

  57. Montalvo, F., & Edward Codina, G. (2001). Skin color and Latinos in the United States. Ethnicities, 1(3), 321–341.

  58. Nagel, J. (1994). Constructing ethnicity: Creating and recreating ethnic identity and culture. Social Problems, 41(1), 152–176.

  59. National Center for Health Statistics (NCHS). (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. MD: Hyattsville.

  60. Painter, M., Holmes, M., & Bateman, J. (2015). Skin tone, race/ethnicity, and wealth inequality among new immigrants. Social Forces, 94(3), 1153–1185.

  61. Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35(4), 888–901.

  62. Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554.

  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.

  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.

  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.

  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.

  67. Phinney, J. S. (1996). Understanding ethnic diversity: The role of ethnic identity. American Behavioral Scientist, 40(2), 143–152.

  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.

  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.

  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.

  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.

  73. Saperstein, A., & Penner, A. M. (2012). Racial fluidity and inequality in the United States. American Journal of Sociology, 118(3), 676–727.

  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.

  75. Schulz, A. J., & Mullings, L. (2006). Gender, race, class, and health: Intersectional approaches. San Francisco, CA: Jossey-Bass.

  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.

  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.

  78. Thoits, P. A. (2010). Stress and health major findings and policy implications. Journal of Health and Social Behavior, 51(1 suppl), S41–S53.

  79. Tichenor, D. J. (2009). Dividing lines: The politics of immigration control in America. Princton, NJ: Princeton University Press.

  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.

  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.

  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.

  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.

Download references


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 (

Author information

Correspondence to Krista M. Perreira.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Perreira, K.M., Wassink, J. & Harris, K.M. Beyond Race/Ethnicity: Skin Color, Gender, and the Health of Young Adults in the United States. Popul Res Policy Rev 38, 271–299 (2019).

Download citation


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