Perceived Racism and Health Among Black Americans: The Role of Racial Identity as a Moderator Over Time

Abstract

Perceived racism is an important health stressor, but few studies explore resources that moderate the association between perceived racism and health over time. Most previous research models racial identity as a main effect and its moderating potential remains unclear. In this study, I use the Stress Process Model to test whether racial identity moderates the association between perceived racism and changes in self-rated health among Black Americans. Data from the American Changing Lives study are used to test this research question (n = 388). Strength of racial identity moderates the association between perceived racism and changes in self-rated health. A strong racial identity buffers the relationship between perceived racism and health for low levels of racism. However, a strong racial identity exacerbates this association for those experiencing high levels of racism. These findings suggest that racial identity may be a protective factor, but it does not buffer against chronic exposure to racism. This study contributes to the existing literature by highlighting that whether racial identity is health-protective against perceived racism depends on the level of perceived racism Black Americans experience. Future studies should continue investigating the conditions under which racial identity buffers the perceived racism-health association.

Keywords

racial identity Black Americans racism stress process

Introduction

Recent health stratification research is increasingly sensitive to the role perceived racism¹ plays in shaping physical and mental health outcomes (Colen et al., 2018; Moody et al., 2019). Perceived racism at the interpersonal level is generally associated with adverse physical and mental health (Cobb et al., 2020; Schulz et al., 2006). However, few studies examine long-term temporal patterns between perceived racism and health (Gee et al., 2019). Further, there is limited knowledge concerning what psychosocial resources Black Americans possess that may buffer the effects of perceived racism on health over time.

In this paper, I examine whether strength of racial identity, defined as closeness to racial group, moderates the association between perceived racism and health among Black Americans. Using prospective data from the American Changing Lives Study (ACL), I investigate strength of racial identity’s moderating role between perceived racism and changes in self-rated health.

Background

Racial Health Disparities

Most research on racial health disparities suggests that, relative to whites, Black Americans have worse health outcomes² (Gilbert et al., 2016; Priest & Williams, 2018). Social science research increasingly explores structural and social psychological explanations for racial health inequities. Health scholars generally find that socioeconomic status has protective health effects and may be a fundamental cause of health outcomes (Phelan et al., 2010). However, significant racial health disparities exist even when adjusting for socioeconomic status and other relevant covariates (Bower et al., 2020; Turner et al., 2017). Regardless of social and economic resources, racial minorities face chronic racism (Jackson, 2005; Lewis et al., 2006; Williams et al., 2019) and inferior access to medical services, insurance, and preventative care (Fang & Alderman, 2004; Wheeler & Bryant, 2017). Hence, some argue that racism is a fundamental cause of health disparities (Phelan & Link, 2015; Williams, 1997). It is well established that significant racial health disparities exist, but less is known about what psychosocial resources may mitigate the harmful effects of racism on health.

The Current Study

In the current study, I use the stress process model and the life course perspective to understand whether strength of racial identity buffers the association between racism and changes in self-rated health. The stress process model is helpful for understanding and analyzing the effect of racism on health. It posits that social status and social environment affect stress exposure. These stressors, in turn, negatively influence health. The stress process model also emphasizes that personal and social resources can protect health directly or indirectly by “buffering” stressors (Brown & Hargrove, 2018; Keith, 2013; Pearlin et al., 1981). Race scholars argue that the U.S. is a racialized social system characterized by hierarchical social relations. Economic, social, and psychological resources are unevenly distributed depending on the group’s position in the hierarchy (Bonilla-Silva, 1997). Consequently, Black Americans are more likely to experience racism and the adverse health effects associated with racialized stress (Priest & Williams, 2018). In this case, racism is a stressor that negatively affects Black American health. At the individual level, Black Americans have different personal and social resources to cope with stressors. These resources may mitigate the impact of stress on health over the life course (Pearlin et al., 2005). For instance, research indicates that social support protects Black American health against different stressors (Taylor et al., 2015). Here, I conceptualize racial identity as an individual psychosocial resource that may buffer the harmful effects of racism on health.

The life course perspective posits that current individual outcomes are best understood using a long-term analytical lens (George, 2013). Most research on racism and health is cross-sectional and potentially misses long-term temporal patterns (Gee et al., 2019). A life course emphasis on changes over time enhances the study of racism and health. The life course perspective acknowledges that intergroup differences are important. Still, it stresses that within-group variation and long-term changes can help researchers understand how specific social processes operate over time. Most race and health studies focus on between-group variation, potentially overlooking within-group variation. Additionally, the life course perspective emphasizes how exposure frequency impacts intragroup variation. In this case, frequency of perceived racism may have significant consequences for Black individuals. Single episodes or occasional perceived racism may have different long-term implications than chronic perceived racism.

Perceived Racism and Health

A growing number of studies explore the role of racism, including perceived racism, in explaining racial health disparities (Neblett, 2019; Williams et al., 2019). Overwhelmingly, perceived racism is associated with many suboptimal health outcomes. Some studies show perceived racism is related to risk factors such as avoiding or delaying medical attention for health conditions (Alcalá & Cook, 2018; Rhee et al., 2019). Other studies document the association between perceived racism and increased smoking and alcohol consumption (Borrell et al., 2010). However, these associations are not limited to risk factors (Lewis et al., 2009). Relevant to the current study, research consistently shows that perceived discrimination is linked to poor self-rated health (Brondolo et al., 2011; Christie-Mizell et al., 2017) which is considered a robust predictor of health outcomes, including mortality (Goldman et al., 2017). Hence, significant evidence suggests that how individuals interpret what happens to them is critical to how racism shapes health.

The above research underscores the increasing focus on perceived racism as an explanatory variable for racial-ethnic health disparities. One understudied area in this line of research concerns what social resources racial minorities have that potentially buffer the association between perceived racism and health (Pascoe & Richman, 2009). A few recent papers represent an essential first step toward understanding psychosocial mechanisms that protect Black health over time (Brown & Hargrove, 2018; Thorpe & Whitfield, 2018), but they focus on Black men’s health. Other research investigates buffering mechanisms (Banks & Kohn-Wood, 2007; Sellers et al., 2006). These studies mainly examine religion and psychosocial indicators (Nguyen et al., 2017; Taylor et al., 2015) as resources that buffer the effects of perceived racism on health. However, the general lack of longitudinal datasets with sufficient numbers of Black Americans has been problematic, limiting current understandings of how these processes work over time.

Strength of Racial Identity as a Buffering Mechanism

Racial identity is a multidimensional construct that includes belonging, positive group evaluation, public regard, racial centrality, and involvement in racially defined activities (Cokley, 2007; Helms, 1990). Scholars generally conceptualize and measure this construct as an individual-level resource. Researchers posit that a strong racial identity can buffer stressors (Phinney et al., 2001) through two mechanisms: higher levels of self-esteem and increased social support (Hughes et al., 2014).

Racial identity is theorized to protect the self-esteem of target groups. Targets with stronger racial identities are more likely to attribute negative racial experiences to uncontrollable external characteristics rather than stable internal ones (Branscombe et al., 1999). Rather than internalize racial insults as personal failings, targets can identify when racism is directed at the group the individual belongs to rather than their person (Brondolo et al., 2009; Cross, 2005). Therefore, racism is seen as a function of the dominant group’s view toward the target group instead of an individual failing, thus providing a buffer to self-esteem injury. Racial identity is also associated with active/approach coping mechanisms (Phinney & Chavira, 1995; Scott, 2003). Racial identity formation provides minority group members with opportunities to share coping strategies, including cultural social support. In turn, this support has the potential to buffer some of the damaging effects that perceived racism has on health.

The existing literature on racial identity and health is mixed. Some investigators find that racial identity intensifies the negative association between perceived racism and mental health (Lee, 2003, 2005; Noh et al., 1999). Others indicate that strength of racial identity weakens this relationship (Banks & Kohn-Wood, 2007; Christie-Mizell et al., 2017; Sellers et al., 2006). A few scholars suggest that only specific racial identity dimensions protect health (Hughes et al., 2014). These divergent findings, at least partly, result from sample and measurement differences. Research on Asian Americans and Asian immigrants primarily suggests that a strong racial identity amplifies the association between racism and health (Lee, 2003, 2005). On the other hand, most research on Black Americans suggests it weakens the association (Banks & Kohn-Wood, 2007; Sellers et al., 2006). Some recent work suggests that racial identity is associated with poor mental health among Black Americans (Monk, 2020), but racial identity is an independent variable, not a moderator. In addition, researchers focus on different aspects of racial identity. For example, some research suggests that only positive group evaluation positively affects health (Hughes et al., 2014). Other studies emphasize that different racial identity dimensions may be salient for various health outcomes (Sellers et al., 2006). Despite the sample and measurement differences, most studies investigating racial identity find it protective for health (Kiang et al., 2006; Mossakowski, 2003). This is especially true for Black Americans (Fischer & Shaw, 1999; Neblett et al., 2004).

The current study adds to the literature by exploring whether racial identity moderates the relationship between perceived racism and self-rated health over time. While there is substantial research on racial identity and health, most research models racial identity as a main effect. Fewer studies examine whether racial identity moderates the association between perceived racism and health (Pascoe & Richman, 2009). In both cases, this literature overwhelmingly analyzes mental health outcomes such as depressive symptoms, psychological well-being, and self-concept (Banks & Kohn-Wood, 2007; Sellers et al., 2006). Less research explores whether racial identity operates similarly for self-rated health. Moreover, much of the work in this area does not examine the role that racial identity may play in shaping health over time.

Hypothesis

Overall, the research literature suggests that racial identity works to attenuate the adverse effects of perceived racism on mental health. Noteworthy for the current study, most studies on Black Americans find buffering effects. The few studies identifying that racial identity exacerbates the perceived racism-health association focus on Asian Americans. The latter studies focus on cultural-specific coping strategies coupled with strong racial-ethnic identity. These factors generally intensify the negative impact of perceived racism on mental health. Only one study finds similar results among Black Americans (Sanders Thompson, 1996). Few studies model racial identity as a buffering mechanism on health outcomes other than mental health. Nonetheless, I expect racial identity to work similarly for self-rated health. Therefore, I hypothesize that racial identity will moderate the relationship between perceived racism and changes in self-rated health over time.

The life course perspective argues that while mere exposure to stressors, such as racism, is important, research investigations also need to account for frequency of exposure (George, 2013). This matters for the current analysis because some studies indicate that racial identity may work differently depending on how persistently individuals experience racism. While these studies are not longitudinal, they do offer important insight. For instance, Lee (2005) finds that ethnic identity moderates the association between perceived racism and mental health. In their study, racial identity only buffers this association when perceived discrimination is low, but their study population is Korean Americans and not Black Americans. As mentioned above, most studies focusing on Black Americans find that racial identity is protective. Branscombe et al. (1999) also discuss different expectations based on exposure length, but they do not test them directly. Research on perceived discrimination exposure and health suggests that chronic exposure has more potent effects (Dugan et al., 2017; Lewis et al., 2006). Hence, a strong racial identity may be a protective factor, but it may not entirely counteract the negative consequences of persistent racism.

Hypothesis: Strength of racial identity will buffer the relationship between perceived racism and changes in self-rated health, but only when perceived racism is low.

Data and Methods

Data

This study uses data from American Changing Lives (ACL) study, a nationally representative panel study funded by the National Institute on Aging (House et al., 2005). The ACL has five waves: 1986, 1989, 1994, 2001 to 2002, and 2011. The ACL oversamples for Black Americans and is a unique longitudinal study since it includes racial identity measures. The analytic sample for the current study consists of all Black American respondents present in the sample from Wave 1 to Wave 4 with valid data on variables used in the study (n = 388). At Wave 1, the ACL includes 1,172 Black Americans. Most missing cases are due to attrition from Wave 1 to Wave 4 (deceased = 434; non-response = 296). Of the remaining 54 missing respondents, 46 have missing data on perceived racism. Respondents with missing data from the analytic sample for two reasons. First, approximately 60% of sample attrition occurred before Wave 3 when perceived racism was measured. Second, deaths account for 77% of attrition between Waves 3 and 4. Respondents interviewed in all four waves were, on average, younger, more likely to have at least a college education, and had better self-rated health at baseline relative to those who were not followed for the entire 16-year period. Racial identity levels do not vary significantly between survivors and those lost to attrition.

Self-Rated Health

Self-rated health is a single-item measure at each wave. Wave 4 self-rated health is the outcome variable, but Wave 1 self-rated health is also included in the regression models to analyze changes over time. This item ranges from a minimum value of 1 (poor) to a maximum value of 5 (excellent). Previous research indicates that self-rated health is a significant predictor of mortality (DeSalvo et al., 2006; Goldman et al., 2017). A few studies find that the predictive power of self-rated health varies by racial/ethnic group (Assari et al., 2016; Woo & Zajacova, 2017), but most of the literature suggests it continues to be a significant predictor of survival for Black Americans (Idler & Benyamini, 1997; Kawada, 2003). Goldman et al. (2017) find that while the predictive power of self-rated health is weaker for Black Americans (relative to White Americans), it remains the strongest overall predictor of survival for Black Americans (see pp. 550–554).

Stress Measure: Perceived Racism

Perceived racism measures whether respondents report receiving unfair treatment because of their race over their lifetime. This item was measured in Wave 3. If respondents reported experiencing racism, they received a follow-up question regarding how often they experienced this treatment. Frequency of perceived racism is the measure of racism used here. Valid item responses range from 1 (never) to 4 (often). The “often” and “sometimes” categories are as coded as 1 and the “rarely” and “never” categories as 0.

Strength of Racial Identity

Strength of Racial identity is measured using closeness to one’s racial group at Wave 1. The item asks respondents to rate how close they feel to their self-reported racial group. Responses range from 1 (not close at all) to 4 (very close). Since the main interest here is how a strong racial identity operates in the relationship between racism and health, “very close” is coded as 1 and “fairly,” “not too close” and “not close at all” as 0.

I treat racial identity as stable over time. The few longitudinal studies on racial identity find it is somewhat stable across different life stages (Scottham et al., 2008; Sellers et al., 2003). Further, the racial identity measure used here, closeness, is most proximate to racial centrality (Sellers et al., 1998, 2006) which research suggests is more stable than other dimensions (Seaton et al., 2009).

Interaction

Because the interaction between perceived racism and racial identity was statistically significant, I created indicator variables of the combinations between perceived racism and racial identity. Low racism-low racial identity is the reference group in the regression models.

Covariates

Educational attainment is used as a measure of socioeconomic status in this analysis. This is a dichotomous variable where respondents with at least a bachelor’s degree (16 years of education or more in 1986 (W1) are coded as 1. Additional models including educational attainment, family income, and wealth (along with employment and marital status) were also estimated, but the study’s conclusions were unchanged.

Age is measured in number of chronological years. Sex is a dummy variable with female coded 1. Region is a dummy variable with South coded as 1 and all other regions coded as 0. Religious service attendance is a continuous variable that ranges from 1 (never) to 5 (at least once a week). All covariates were measured at Wave 1.

Analytic Strategy

I use ordered logistic regression to model the association between the variables of interest and changes in self-rated health using Stata 17.0 (StataCorp, 2021). A Brant test was conducted to test the parallel odds assumption and the results suggest that the model satisfies the ordered logistic regression restriction that variable coefficients are equal across dependent variable categories (χ² = 20.51 (27), p = .809). There are three regression models. Model 1 includes the covariates, perceived racism, and Wave 1 self-rated health. Strength of racial identity is added in Model 2. In Model 3, the interaction is tested using the indicators variables for racism-racial identity (low-low is the reference group).

Results

Describing the Sample

Table 1 shows sample characteristics for variables in the analyses. The mean level of self-rated health declines from 3.54 in Wave 1 to 3.11 in Wave 4. The percentage of Black Americans reporting “very good” or “excellent” declines from 56.96% in Wave 1 to 37.63% in Wave 4. Approximately 32% of the sample reports experiencing racism often or sometimes. However, significant socioeconomic status differences are worth noting (not shown here). Approximately 28% of Black Americans without a bachelor’s degree report experiencing racism often or sometimes compared to 59.6% of those who had attained at least a bachelor’s degree. This socioeconomic pattern is consistent with previous research (Jackson & Williams, 2006).

Table 1.

Sample Characteristics.

	n = 388
Self-rated health
W1(mean)	3.5
Excellent	19.6%
Very good	37.4%
Good	23.9%
Fair	15.5%
Poor	3.6%
W4(mean)	3.1
Excellent	8.0%
Very good	29.6%
Good	34.3%
Fair	21.4%
Poor	6.7%
College degree (W1)	12.1%
Perceived racism (W3)
Often/Sometimes	31.7%
Rarely/Never	68.3%
Strength of racial identity (W1)
Very Close	58.0%
Fairly/Not Close/Not Close at All	42.0%
Age (W1; mean)	46.0
Female (W1)	69.6%
South census region (W1)	56.2%
Religious service attendance (W1)
At least once weekly	47.9%
2 or 3 times a month	21.4%
About once a month	10.8%
Less than 1×/month	11.9%
Never	8.0%

Overall, 58% of Black Americans report feeling very close to their racial group. Socioeconomic differences in racial identity are less pronounced than perceived racism. Over 57 and 66% of Black Americans with at least a bachelor’s degree and those with less than a bachelor’s degree, respectively, report feeling very close to members of their race. This descriptive finding is in line with previous findings that Black American group solidarity does not vary significantly by socioeconomic position (Shelton & Wilson, 2006).

Approximately 12% of Black Americans in the ACL have at least a college degree (in 1986), consistent with national figures. According to 1985 U.S. Census data, approximately 11% of Black Americans had completed 4 years of college or more (U.S. Census Bureau, 1999).

The sample mean age at Wave 1 is 46.02 years. Seventy percent of the study sample is female and approximately 56% of Black respondents live in the South Census Region. Forty-eight percent of the sample reports attending religious services at least once weekly in Wave 1.

Results from Ordered Logistic Regression Models

The ordered logistic regression results are shown in Table 2. Model 1 includes Wave 1 self-rated health, the covariates, and perceived racism. As expected, Wave 1 self-rated health is significantly associated with Wave 4 self-rated health. Specifically, those with better Wave 1 self-rated health are more likely to report better health in Wave 4. Also, as expected, perceived racism is significantly and negatively associated with Wave 4 self-rated health. Black Americans who report experiencing racism often or sometimes have worse self-rated health than those who say they rarely or never experience racism. In contrast, educational attainment is not significantly associated with Wave 4 self-rated health. Age is negatively associated with Wave 4 self-rated health; females have lower levels of self-rated health relative to males. There are no significant self-rated health differences between the South and other U.S. regions. Religious service attendance also is not significantly associated with Wave 4 self-rated health.

Table 2.

Ordered Logit Coefficients for Wave 4 Self-Rated Health. American Changing Lives (n = 388).

	Model 1		Model 2		Model 3
	Coefficient	SE	Coefficient	SE	Coefficient	SE
SRH Wave 1	0.656***	0.098	0.625***	0.099	0.621***	0.099
Perceived Racism	−0.719***	0.208	−0.716***	0.211
Education (1 = BA)	0.348	0.290	0.301	0.291	0.318	0.292
Age	−0.024***	0.007	−0.025***	0.007	−0.026***	0.007
Gender (1 = female)	−0.504**	0.211	−0.546**	0.214	−0.532**	0.214
South	0.008	0.192	−0.016	0.194	−0.055	0.195
Religious Attendance	−0.025	0.073	−0.041	0.074	−0.048	0.074
Strength of Race Identity			0.237	0.191
Ref. (Low Racism-Low Ident)
High Racism-Low Ident.					−0.188	0.317
Low Racism-High Ident.					0.521**	0.230
High Racism-High Ident.					−0.587**	0.288
Constant	3.315***	0.647	3.247***	0.652	3.335***	0.655

Note. SE = standard error.

***

p < .01. **p < .05.

Strength of racial identity is added in Model 2. The main effect of strength of racial identity is not significantly associated with Wave 4 self-rated health. Perceived racism, Wave 1 self-rated health, age, and sex remain significant predictors in this model. Model 3 tests the interaction between perceived racism and strength of racial identity using three racism-racial identity combinations. Low racism-low racial identity is the reference group. Black Americans who experience low levels of perceived racism and have a strong racial identity report significantly better self-rated health relative to the reference group. In contrast, Black Americans with high levels of racism and a strong racial identity report significantly lower self-rated health than the reference group. The high racism-low racial identity group is not significantly different from the low racism-low identity group. Figure 1 presents the predicted probabilities of self-rated health for the four combinations of perceived racism and racial identity.

Figure 1.

Predicted probabilities of Wave 4 SRH by racial identity and perceived racism. American changing lives (n = 388).

The findings paint an interesting picture. Racial identity does moderate the association between perceived racism and changes in self-rated health. However, racial identity is only protective when perceived racism is low. The interaction of high levels of perceived racism and a strong racial identity exacerbates the association between perceived racism and self-rated health. Hence, the hypothesis is confirmed. The results support the moderating role of racial identity between perceived racism and changes in self-rated health. They also suggest that racial identity is only protective in this association when Black Americans experience low levels of perceived racism.

Discussion

In this paper, using the stress process model, I argue that strength of racial identity moderates the association between perceived racism and self-rated health over time. The findings indicate that perceived racism is negatively associated with changes in self-rated health for Black Americans. The interaction between perceived racism and strength of racial identity reveals that strength of racial identity buffers the association between perceived racism and changes in self-rated health for Black Americans with lower levels of perceived racism. The opposite is true for those experiencing higher levels of perceived racism. Specifically, Black Americans that report experiencing racism often or sometimes have worse self-rated health if they have a strong racial identity. Hence, having a strong racial identity appears to be a significant buffering psychosocial resource for Black Americans who encounter lower levels of perceived racism. Some previous research suggests that racial identity works as a moderator by making targets more likely to attribute race-related racism to external factors rather than internalizing these experiences as personal failures (Brondolo et al., 2009; Cross, 2005). The current findings suggest that whether racial identity buffers the association of interest here depends on the frequency of perceived racism. It was not possible to directly test whether strength of racial identity leads to different attributions for perceived racism. However, it is plausible that in the face of higher levels of perceived racism, targets may be more likely to internalize these experiences if their racial identity is relatively weak. Still, it is worth considering that a strong racial identity may not be able to counter the negative impact that persistent perceived racism has on self-rated health. In fact, it appears that in the presence of higher levels of perceived racism, a strong racial identity intensifies the negative relationship between perceived racism and changes in self-rated health.

The present findings are partially consistent with Noh et al. (1999) finding that a strong racial identity may exacerbate the association between perceived racism on health. However, this study’s results differ in two regards: (1) their study focuses only on mental health, and (2) it does not examine frequency of racism. First, in this study self-rated health is the outcome variable. Second, Noh et al. (1999) focus on how racial identity is linked to different coping strategies, which in turn are associated with mental health. The current results also partially support Christie-Mizell et al. (2017). They find that racial identity buffers the relationship between discrimination and self-health. However, in their study it buffers for Black Americans who experience high levels of everyday discrimination. Here, racial identity moderates the association between perceived racism and changes in self-rated health, buffering it when perceived racism is low and exacerbating it when perceived racism is high. Therefore, my research partially supports previous findings that suggest racial identity can be a protective factor against the negative impact of racism (Mossakowski, 2003). The results also align with Lee’s (2005) findings among Korean Americans. The contribution here is that racial identity may be a protective factor in the association between perceived racism and health over time, but it may not be enough to combat the adverse effects of chronic racism (Dugan et al., 2017; Lewis et al., 2006). Therefore, racism is negatively associated with changes in self-rated health and it appears that frequent racism coupled with a strong racial identity may be less than ideal.

Another noteworthy finding is that, among Black Americans, educational attainment is not significantly associated with changes in self-rated health. Fundamental cause theory suggests that socioeconomic status is a fundamental cause of health and health disparities (Phelan et al., 2010). Further, self-rated health is a reliable predictor of mortality and other health outcomes (Goldman et al., 2017). Hence, the absence of a significant relationship aligns with previous research on the unequal returns of socioeconomic status to the health of Black Americans. The findings support the idea that socioeconomic status may not be a fundamental cause of Black health (see Turner et al., 2017). However, given the limited nature of the socioeconomic status measure and some limitations outlined below, this result should be interpreted cautiously. More research incorporating multiple socioeconomic indicators (especially wealth) is warranted (Darity et al., 2021; Hamilton et al., 2015). I conducted regression analyses (available upon request) that included one wealth measure (liquid assets), but wealth was not a significant predictor of changes in self-rated health. Future studies would benefit from more robust wealth measures.

Limitations and Future Directions

Although this paper advances our understanding of how psychosocial resources, specifically racial identity, moderate the relationship between perceived racism and health, it is not without limitations. Future studies should attempt to focus on other dimensions of racial identity. Some previous research finds that only some racial identity dimensions are protective for minority groups (Hughes et al., 2014). The results presented here suggest that closeness to racial group only attenuates the relationship between perceived racism and self-rated health under specific conditions. It would be useful to compare multiple dimensions of racial identity, such as closeness and positive group evaluation to examine how they moderate the negative association between perceived racism and health. Moreover, the current racial identity measure may miss significant distinctions, such as closeness to specific sub-groups (e.g., feeling close to other middle-class Black Americans but more distant from working-class individuals who belong to the same racial group).

The current study is not able to determine whether nativity and ethnicity influence racial identity’s moderating role between perceived racism and health. Recent studies suggest that nativity and ethnic origin play an important role in shaping how psychosocial resources moderate the association between perceived racism and health (Christie-Mizell et al., 2017; Ida & Christie-Mizell, 2012). The current sample only included 20 foreign-born Black Americans, so it was not feasible to incorporate nativity as a covariate.

Another limitation of the current study is the small sample size. The analytic sample includes 388 Black respondents. This limitation is partly due to the general lack of nationally representative panel studies with a large sample of Black Americans and the variables of interest in the study. The ACL oversamples Black respondents and has the key variables of interest, but the sample size is not ideal. The study results are likely affected by selective attrition over this time (Biering et al., 2015). As described above, respondents interviewed in all four waves had higher self-rated health, were more likely to have a college degree, and were younger than respondents lost to attrition.

Because of data limitations, I was not able to construct trajectories. As discussed above, racial identity and perceived racism are only measured at one time point. While the current investigation contributes to our understanding of how racial identity moderates the association between racism and health over time, future studies would benefit from investigating how trajectories of racial identity may impact health trajectories. Research indicates that racial identity may be associated with perceptions of racism (Franklin-Jackson & Carter, 2007; Hall & Carter, 2006). Further, the little longitudinal research suggests that racial identity can both influence perceptions of racism and act as a buffer between racism and health (Sellers et al., 2003). The few longitudinal studies on racial identity suggest that it is somewhat stable over time (Scottham et al., 2008). However, the literature would benefit from studies that observe multiple racial identity dimensions into late adulthood.

Conclusion

The current study finds that racial identity moderates the association between perceived racism and changes in self-rated health. It buffers this relationship when perceived racism is low. Conversely, when perceived racism is high, racial identity exacerbates the association between perceived racism and self-rated health. Therefore, one of the main takeaways is that racial identity is not inherently negative and solutions should not de-emphasize racial identity.

While psychosocial resources may not be the answer to structural racism (Bonilla-Silva, 2018), they may be essential tools that individuals can use to weaken the adverse effects of perceived racism on health. Future investigations can continue to examine how psychosocial factors work in the relationship between perceived racism and health.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Aging (T32 AG000139).

ORCID iD

Carlos Daniel Tavares

Notes

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