Skip to main content
    • Aa
    • Aa

MEASURING EVERYDAY RACIAL/ETHNIC DISCRIMINATION IN HEALTH SURVEYS: How Best to Ask the Questions, in One or Two Stages, Across Multiple Racial/Ethnic Groups?1

  • Salma Shariff-Marco (a1), Nancy Breen (a2), Hope Landrine (a3), Bryce B. Reeve (a2), Nancy Krieger (a4), Gilbert C. Gee (a5), David R. Williams (a6), Vickie M. Mays (a7), Ninez A. Ponce (a8), Margarita Alegría (a9), Benmei Liu (a10), Gordon Willis (a2) and Timothy P. Johnson (a11)...

While it is clear that self-reported racial/ethnic discrimination is related to illness, there are challenges in measuring self-reported discrimination or unfair treatment. In the present study, we evaluate the psychometric properties of a self-reported instrument across racial/ethnic groups in a population-based sample, and we test and interpret findings from applying two different widely-used approaches to asking about discrimination and unfair treatment. Even though we found that the subset of items we tested tap into a single underlying concept, we also found that different groups are more likely to report on different aspects of discrimination. Whether race is mentioned in the survey question affects both frequency and mean scores of reports of racial/ethnic discrimination. Our findings suggest caution to researchers when comparing studies that have used different approaches to measure racial/ethnic discrimination and allow us to suggest practical empirical guidelines for measuring and analyzing racial/ethnic discrimination. No less important, we have developed a self-reported measure of recent racial/ethnic discrimination that functions well in a range of different racial/ethnic groups and makes it possible to compare how racial/ethnic discrimination is associated with health disparities among multiple racial/ethnic groups.

Corresponding author
Salma Shariff-Marco, Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538. E-mail:
Hide All

We would like to thank the NCI Division of Cancer Control and Population Sciences (DCCPS) and the NIH Office of Behavioral Social Sciences Research for co-funding the 2007 field test, and NCI DCCPS for providing staff for this project. We would also like to acknowledge the Cancer Prevention Fellowship Program, Office of Preventive Oncology, National Cancer Institute, for providing financial support for S. Shariff-Marco in her postdoctoral fellowship; Tim McNeel and William Waldron at IMS for their programming support; and Penny Randall-Levy of the Scientific Consulting Group, Inc., for her help with the references. We would also like to acknowledge Drs. David Grant, E. Richard Brown, and David Takeuchi for their participation in this research project. Finally, we would like to acknowledge Drs. William Klein and Rachel Ballard-Barbash for their thoughtful reviews.

Hide All
Albert Michelle A., Cozier Yvette, Ridker Paul M., Palmer Julie R., Glynn Robert J., Rose Lynda, Halevy Nitsan, and Rosenberg Lynn (2010). Perceptions of Race/Ethnic Discrimination in Relation to Mortality Among Black Women: Results From the Black Women's Health Study. Archives of Internal Medicine, 170(10): 896904.
Barnes Lisa L., de Leon Carlos F. Mendes, Lewis Tene T., Bienias Julia L., Wilson Robert S., and Evans Denis A. (2008). Perceived Discrimination and Mortality in a Population-Based Study of Older Adults. American Journal of Public Health, 98(7): 12411247.
Bastos Joao Luiz, Celeste Roger Keller, Faerstein Eduardo, and Barros Aluisio J. (2010). Racial Discrimination and Health: a Systematic Review of Scales With a Focus on Their Psychometric Properties. Social Science & Medicine, 70(7): 10911099.
Bobo Lawrence (2001). Racial Attitudes and Relations at the Close of the 20th Century. In Smelser Neil J., Wilson William J., and Mitchell Faith (Eds.), America Becoming: Racial Trends and Their Consequences, Volume 1, pp. 264301. Washington, DC: National Academy Press.
Brown Tony N. (2001). Measuring Self-Perceived Racial and Ethnic Discrimination in Social Surveys. Sociological Spectrum, 21(3): 377392.
California Health Interview Survey (2009). CHIS 2007 Methodology Series Report 4: Response Rates. Los Angeles, CA: UCLA Center for Health Policy Research.
Cameron Christopher David Ruiz (1997). How the Garcia Cousins Lost Their Accents: Understanding the Language of Title VII Decisions Approving English-Only Rules As the Product of Racial Dualism, Latino Invisibility, and Legal Indeterminacy. California Law Review, 85: 13471393.
Carney Dana R., Banaji Mahzarin R., and Krieger Nancy (2010). Implicit Measures Reveal Evidence of Personal Discrimination. Self and Identity, 9(2): 162176.
Chae David H., Takeuchi David T., Barbeau Elizabeth M., Bennett Gary G., Lindsey Jane, and Krieger Nancy (2008). Unfair Treatment, Racial/Ethnic Discrimination, Ethnic Identification, and Smoking Among Asian Americans in the National Latino and Asian American Study. American Journal of Public Health, 98(3): 485492.
Clark Rodney, Anderson Norman B., Clark Vernessa R., and Williams David R. (1999). Racism As a Stressor for African Americans. A Biopsychosocial Model. American Psychologist, 54(10): 805816.
Desmond Matthew and Emirbayer Mustafa (2009). What Is Racial Domination? Du Bois Review: Social Science Research on Race, 6(2): 335355.
Epel Elissa S., Blackburn Elizabeth H., Lin Jue, Dhabhar Firdaus S., Adler Nancy E., Morrow Jason D., and Cawthon Richard M. (2004). Accelerated Telomere Shortening in Response to Life Stress. Proceedings of the National Academy of Sciences of the United States of America, 101(49): 1731217315.
Essed Philomena (1990). Understanding Everyday Racism: an Interdisciplinary Theory. Newbury Park, CA: Sage Publications, Inc.
Feagin Joe R. (2006). Systematic Racism. New York: CRC Press.
Feagin Joe R. and O'Brien Eileen (2003). White Men on Race: Power, Privilege, and the Shaping of Cultural Consciousness. Boston, MA: Beacon Press.
Gee Gilbert C., Ro Annie, Shariff-Marco Salma, and Chae David (2009). Racial Discrimination and Health Among Asian Americans: Evidence, Assessment, and Directions for Future Research. Epidemiologic Reviews, 31: 130151.
Geronimus Arline T. (2001). Understanding and Eliminating Racial Inequalities in Women's Health in the United States: the Role of the Weathering Conceptual Framework. Journal of the American Medical Women's Association 56(4): 133–136, 149–150.
Geronimus Arline T., Hicken Margaret, Keene Danya, and Bound John (2006). “Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States. American Journal of Public Health, 96(5): 826833.
Judkins David, Krenzke Tom, Piesse Andrea, Fan Zizhong, and Haung Wen-Chau (2007). Preservation of Skip Patterns and Covariate Structure Through Semi-Parametric Whole Questionnaire Imputation Proceedings of the Joint Statistical Meetings of the American Statistical Association, pp. 32113288.
Judkins David, Piesse Andrea, and Krenzke Tom (2008). Multiple Semi-Parametric Imputation. Proceedings of the Joint Statistical Meetings of the American Statistical Association, pp. 4858.
Kessler Ronald C., Mickelson Kristin D., and Williams David R. (1999). The Prevalence, Distribution, and Mental Health Correlates of Perceived Discrimination in the United States. Journal of Health and Social Behavior, 40(3): 208230.
Kluegel James R. and Bobo Lawrence D. (2001). Perceived Group Discrimination and Policy Attitudes: the Sources and Consequences of the Race and Gender Gaps. In O'Connor Alice, Tilly Chris, and Bobo Lawrence D. (Eds.), Urban Inequality: Evidence From Four Cities, pp. 163214. New York: Russell Sage Foundation.
Kressin Nancy R., Raymond Kristal L., and Manze Meredith (2008). Perceptions of Race/Ethnicity-Based Discrimination: a Review of Measures and Evaluation of Their Usefulness for the Health Care Setting. Journal of Health Care for the Poor and Underserved, 19(3): 697730.
Krieger Nancy (2000). Discrimination and Health. In Berkman Lisa F. and Kawachi Ichiro (Eds.), Social Epidemiology, pp. 3675. New York: Oxford University Press.
Krieger Nancy (2010). The Science and Epidemiology of Racism and Health: Racial/Ethnic Categories, Biological Expressions of Racism, and the Embodiment of Inequality—an Ecosocial Perspective. In Whitmarsh Ian and Jones David S. (Eds.), What's the Use of Race? Modern Governance and the Biology of Difference, pp. 225255. Cambridge, MA: The MIT Press.
Krieger Nancy, Carney Dana, Lancaster Katie, Waterman Pamela D., Kosheleva Anna, and Banaji Mahzarin (2010). Combining Explicit and Implicit Measures of Racial Discrimination in Health Research. American Journal of Public Health, 100(8): 14851492.
Krieger Nancy and Sidney Stephen (1996). Racial Discrimination and Blood Pressure: the CARDIA Study of Young Black and White Adults. American Journal of Public Health, 86(10): 13701378.
Krieger Nancy, Smith Kevin, Naishadham Deepa, Hartman Cathy, and Barbeau Elizabeth M. (2005). Experiences of Discrimination: Validity and Reliability of a Self-Report Measure for Population Health Research on Racism and Health. Social Science & Medicine, 61(7): 15761596.
Krysan Maria and Couper Mick P. (2003). Race in the Live and the Virtual Interview: Racial Deference, Social Desirability, and Activation Effects in Attitude Surveys. Social Psychology Quarterly, 66(4): 364383.
Landrine Hope, Klonoff Elizabeth A., Corral Irma, Fernandez Senaida, and Roesch Scott (2006). Conceptualizing and Measuring Ethnic Discrimination in Health Research. Journal of Behavioral Medicine, 29(1): 7994.
Lee Sunghee, Satter Delight E., and Ponce Ninez A. (2009). Effect of Race and Ethnicity Classification on Survey Estimates: Anomaly of the Weighted Totals of American Indians and Alaska Natives. American Indian and Alaska Native Mental Health Research, 16(3): 115.
Lewis Tene T., Aiello Allison E., Leurgans Sue, Kelly Jeremiah, and Barnes Lisa L. (2010). Self-Reported Experiences of Everyday Discrimination Are Associated With Elevated C-Reactive Protein Levels in Older African-American Adults. Brain, Behavior, and Immunity, 24(3): 438443.
Lewis Tene T., Everson-Rose Susan A., Powell Lynda H., Matthews Karen A., Brown Charlotte, Karavolos Kelly, Sutton-Tyrrell Kim, Jacobs Elizabeth, and Wesley Deidre (2006). Chronic Exposure to Everyday Discrimination and Coronary Artery Calcification in African-American Women: the SWAN Heart Study. Psychosomatic Medicine, 68(3): 362368.
Liang Christopher T., Li Lisa C., and Kim Bryan S. (2004). The Asian American Racism-Related Stress Inventory: Development, Factor Analysis, Reliability, and Validity. Journal of Counseling Psychology, 51(1): 103114.
Massey Douglas S. and Lundy Garvey (2001). Use of Black English and Racial Discrimination in Urban Housing Markets: New Methods and Findings. Urban Affairs Review, 36(4): 452469.
Mays Vickie M., Cochran Susan D., and Barnes Namdi W. (2007). Race, Race-Based Discrimination, and Health Outcomes Among African Americans. Annual Review of Psychology, 58: 201225.
Mays Vickie M., Ponce Ninez A., Washington Donna L., and Cochran Susan D. (2003). Classification of Race and Ethnicity: Implications for Public Health. Annual Review of Public Health, 24: 83110.
Muthen Linda K. and Muthen Bengt O. (2007). Mplus (Version 4.21) Software. Los Angeles, CA: Muthen & Muthen.
National Research Council (2004). Measuring Racial Discrimination. Panel on Methods for Assessing Discrimination. Washington, DC: The National Academies Press.
Nunnally Jum C. and Bernstein Ira H. (1994). Psychometric Theory, 3ed.New York: McGraw Hill Co.
Office of Management and Budget (1997). Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Office of Management and Budget Directive 15. U.S. Census Bureau. ⟨⟩ (accessed October 3, 2010).
Paradies Yin (2006). A Systematic Review of Empirical Research on Self-Reported Racism and Health. International Journal of Epidemiology, 35(4): 888901.
Pascoe Elizabeth A. and Smart Richman Laura (2009). Perceived Discrimination and Health: a Meta-Analytic Review. Psychological Bulletin, 135(4): 531554.
Piesse Andrea, Judkins David R., and Fan Zizhong (2005). Item Imputation Made Easy. Proceedings of the Survey Research Methods Section of the American Statistical Association, pp. 25402546.
Pincus Fred L. (2003). Reverse Discrimination: Dismantling the Myth. Boulder, CO: Lynne Rienner Publishers.
Reeve Bryce B. and Fayers Peter (2005). Applying Item Response Theory Modelling for Evaluating Questionnaire Item and Scale Properties. In Fayers Peter and Hays Ron (Eds.), Assessing Quality of Life in Clinical Trials: Methods and Practice, 2ed., pp. 5573. New York: Oxford University Press.
Reeve Bryce B., Hays Ron D., Bjorner Jakob B., Cook Karon F., Crane Paul K., Teresi Jeanne A., Thissen David, Revicki Dennis A., Weiss David J., Hambleton Ronald K., Liu Honghu, Gershon Richard, Reise Steven P., Lai Jin-shei, and Cella David (2007). Psychometric Evaluation and Calibration of Health-Related Quality of Life Item Banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Medical Care, 45(5 Suppl 1): S22S31.
Reeve Bryce B., Willis Gordon, Shariff-Marco Salma N., Breen Nancy, Williams David R., Gee Gilbert C., Alegria Margarita, Takeuchi David T., Kudela Martha S., and Levin Kerry Y. (Forthcoming). Comparing Cognitive Interviewing and Psychometric Methods to Evaluate a Racial/Ethnic Discrimination Scale. Field Methods.
Research Triangle Institute (2008). SUDAAN (Release 10.0). Research Triangle Park, NC: Research Triangle Institute.
Roussos Louis and Stout William (1996). A Multidimensionality-Based DIF Analysis Paradigm. Applied Psychological Measurement, 20(4): 355371.
Seeman Teresa E., Singer Burton H., Ryff Carol D., Love Gayle Dienberg, and Levy-Storms Lene (2002). Social Relationships, Gender, and Allostatic Load Across Two Age Cohorts. Psychosomatic Medicine, 64(3): 395406.
Shariff-Marco Salma, Gee Gilbert C., Breen Nancy, Willis Gordon, Reeve Bryce B., Grant David, Ponce Ninez A., Krieger Nancy, Landrine Hope, Williams David R., Alegria Margarita, Mays Vickie M., Johnson Timothy P., and Brown E. Richard (2009). A Mixed-Methods Approach to Developing a Self-Reported Racial/Ethnic Discrimination Measure for Use in Multiethnic Health Surveys. Ethnicity & Disease, 19(4): 447453.
Spencer Michael S. and Chen Juan (2004). Effect of Discrimination on Mental Health Service Utilization Among Chinese Americans. American Journal of Public Health, 94(5): 809814.
Swan Judith, Breen Nancy, Burhansstipanov Linda, Satter Delight E., Davis William W., McNeel Timothy, and Snipp C. Matthew (2006). Cancer Screening and Risk Factor Rates Among American Indians. American Journal of Public Health, 96(2): 340350.
Taylor Teletia R., Williams Carla D., Makambi Kepher H., Mouton Charles, Harrell Jules P., Cozier Yvette, Palmer Julie R., Rosenberg Lynn, and Adams-Campbell Lucile L. (2007). Racial Discrimination and Breast Cancer Incidence in US Black Women: the Black Women's Health Study. American Journal of Epidemiology, 166(1): 4654.
Teresi Jeanne A. and Fleishman John A. (2007). Differential Item Functioning and Health Assessment. Quality of Life Research, 16(Suppl 1): 3342.
Thissen David L. (2001). IRTLRDIF (v. 2.0b): Software for the Computation of the Statistics Involved in Item Response Theory Likelihood-Ratio Tests for Differential Item Functioning. Chapel Hill, NC: Thurstone Psychometric Laboratory.
Thissen David, Steinberg Lynne, and Wainer Howard (1993). Detection of Differential Item Functioning Using the Parameters of Item Response Models. In Holland Paul W. and Wainer Howard (Eds.), Differential Item Functioning, pp. 67113. Hillsdale, NJ: Lawrence Erlbaum Associates.
Tomfohr Lianne, Cooper Denise C., Mills Paul J., Nelesen Richard A., and Dimsdale Joel E. (2010). Everyday Discrimination and Nocturnal Blood Pressure Dipping in Black and White Americans. Psychosomatic Medicine, 72(3): 266272.
Tuan Mia (1998). Forever Foreigners or Honorary Whites? The Asian Ethnic Experience Today. New Brunswick, NJ: Rutgers University Press.
Turner Margery A. and Skidmore Felicity (Eds.) (1999). Mortgage Lending Discrimination: A Review of Existing Evidence. Washington, DC: The Urban Institute.
Wildsmith Elizabeth M. (2002). Testing the Weathering Hypothesis Among Mexican-Origin Women. Ethnicity & Disease, 12(4): 470479.
Williams David R. and Mohammed Selina A. (2009). Discrimination and Racial Disparities in Health: Evidence and Needed Research. Journal of Behavioral Medicine, 32(1): 2047.
Williams David R., Mohammed Selina A., Leavell Jacinta, and Collins Chiquita (2010). Race, Socioeconomic Status, and Health: Complexities, Ongoing Challenges, and Research Opportunities. Annals of the New York Academy of Sciences, 1186: 69101.
Williams David R. and Neighbors Harold (2001). Racism, Discrimination and Hypertension: Evidence and Needed Research. Ethnicity & Disease, 11(4): 800816.
Williams David R., Yu Yan, Jackson James S., and Anderson Norman B. (1997). Racial Differences in Physical and Mental Health: Socio-Economic Status, Stress and Discrimination. Journal of Health Psychology, 2(3): 335351.
Yoo Hyung Chol, Gee Gilbert C., Lowthrop Craig K., and Robertson Joanne (2010). Self-Reported Racial Discrimination and Substance Use Among Asian Americans in Arizona. Journal of Immigrant and Minority Health, 12(5): 683690.
Yoo Hyung Chol, Gee Gilbert C., and Takeuchi David (2009). Discrimination and Health Among Asian American Immigrants: Disentangling Racial From Language Discrimination. Social Science & Medicine, 68(4): 726732.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Du Bois Review: Social Science Research on Race
  • ISSN: 1742-058X
  • EISSN: 1742-0598
  • URL: /core/journals/du-bois-review-social-science-research-on-race
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 12
Total number of PDF views: 80 *
Loading metrics...

Abstract views

Total abstract views: 352 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd October 2017. This data will be updated every 24 hours.