Methodological approaches for studying structural racism and its biopsychosocial impact on health

  • Author Footnotes
    1 Both authors made equal contributions
    Paris B. Adkins-Jackson
    Corresponding author: Paris B. Adkins-Jackson, Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032.
    1 Both authors made equal contributions
    Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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  • Author Footnotes
    1 Both authors made equal contributions
    Angela C. Incollingo Rodriguez
    1 Both authors made equal contributions
    Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, MA
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  • Author Footnotes
    1 Both authors made equal contributions
Published:September 22, 2022DOI:


      • Structural racism creates poor health for racialized and minoritized communities.
      • Structural racism is multilevel and multidimensional.
      • Structural racism should be examined as a predictor of biopsychosocial health.
      • Biopsychosocial approaches are useful for identifying downstream health impacts.
      • Interdisciplinary research is needed in close partnership with communities.



      Structural racism is a powerful determinant of health that drives health disparities, morbidity, and mortality across racialized and minoritized groups.


      This article discusses approaches for measuring structural racism and its resultant network of negative biopsychosocial consequences for health and well-being.


      We draw on prevailing theoretical models and approaches to characterize both the nature of structural racism and integrated methods for assessing its consequences across mental and physical health.


      This article will serve to guide researchers in health-related disciplines to accurately assess the biopsychosocial consequences of structural racism in key populations.


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        • Adkins-Jackson P.B.
        • Sanchez A.V.
        • Ison J.
        • Williams-Gray S.
        Clinical Trials and Trust: Understanding the role of social determinants on clinical trial participation and trust.
        Applied Clinical Trials. 2021; 30
      1. Adkins-Jackson, P.B., Burke, N., Espinoza, G.P., Rosas, G.L., Doubeni, C., Goold, S., & Brown, A.F. (in press). The STOP COVID-19 CA trial participation & vaccine hesitancy workgroups. Inclusionary trials: Lessons not learned in vaccine and clinical trials. Epidemiologic Reviews.

        • Adkins-Jackson P.B.
        • Chantarat T.
        • Bailey Z.D.
        • Ponce N.A.
        Measuring structural racism: A guide for epidemiologists and other health researchers.
        American Journal of Epidemiology. 2021;
        • Adkins-Jackson P.B.
        • Jackson Preston P.A.
        • Hairston T.
        The only way out': How self-care is conceptualized by Black women.
        Ethnicity & health. 2022; (Advance online publication): 1-17
        • Adkins-Jackson P.B.
        • Legha R.K.
        • Jones K.A.
        How to measure racism in academic health centers.
        AMA Journal of Ethics. 2021; 23: E140-E145
        • Alhasanat D.
        • Giurgescu C.
        Acculturation and postpartum depressive symptoms among Hispanic women in the United States: Systematic review.
        The American Journal of Maternal/Child Nursing. 2017; 42: 21-28
        • Bailey Z.D.
        • Feldman J.M.
        • Bassett M.T.
        How structural racism works - Racist policies as a root cause of U.S. racial health inequities.
        The New England Journal of Medicine. 2021; 384: 768-773
        • Bailey Z.D.
        • Krieger N.
        • Agénor M.
        • Graves J.
        • Linos N.
        • Bassett M.T.
        Structural racism and health inequities in the USA: Evidence and interventions.
        Lancet. 2017; 389: 1453-1463
        • Barbarin O.A.
        • Gilbert R.
        Institutional Racism Scale: Assessing Self and Organizational Attributes.
        ERIC, 1981
        • Barnes L.L.
        • Wilson R.S.
        • Everson-Rose S.A.
        • Hayward M.D.
        • Evans D.A.
        • De Leon C.F.M.
        Effects of early-life adversity on cognitive decline in older African Americans and whites.
        Neurology. 2012; 79: 2321-2327
        • Bell C.N.
        • Owens-Young J.L.
        Self-rated health and structural racism indicated by county-level racial inequalities in socioeconomic status: The role of urban-rural classification.
        Journal of Urban Health : Bulletin of the New York Academy of Medicine. 2020; 97: 52-61
        • Berkowitz S.A.
        • Karter A.J.
        • Corbie-Smith G.
        • Seligman H.K.
        • Ackroyd S.A.
        • Barnard L.S.
        • Wexler D.J.
        Food insecurity, food “deserts,” and glycemic control in patients with diabetes: A longitudinal analysis.
        Diabetes Care. 2018; 41: 1188-1195
        • Cachero P.
        From AIDS to COVID-19, America's medical system has a long history of relying on Filipino nurses to fight on the frontlines.
        (May 30) Time Magazine, 2021 (Available at:)
        • Caunca M.R.
        • Odden M.C.
        • Glymour M.M.
        • Elfassy T.
        • Kershaw K.N.
        • Sidney S.
        • Zeki Al Hazzouri A.
        Association of racial residential segregation throughout young adulthood and cognitive performance in middle-aged participants in the CARDIA Study.
        JAMA Neurology. 2020; 77: 1000-1007
        • Chae D.H.
        • Wang Y.
        • Martz C.D.
        • Slopen N.
        • Yip T.
        • Adler N.E.
        • Epel E.S.
        Racial discrimination and telomere shortening among African Americans: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
        Health Psychology. 2020; : 39
        • Chan A.L.
        • Guo N.
        • Popat R.
        • Robakis T.
        • Blumenfeld Y.Y.
        • Main E.
        • Butwick A.J.
        Racial and ethnic disparities in hospital-based care associated with postpartum depression.
        Journal of Racial and Ethnic Health Disparities. 2021; 8: 220-229
        • Chantarat T.
        • Van Riper D.C.
        • Hardeman R.R.
        The intricacy of structural racism measurement: A pilot development of a latent-class multidimensional measure.
        EClinical Medicine. 2021; 40
        • Chisolm D.J.
        • Bell B.A.
        • Yamoah O.
        • Freedman D.A.
        Racialized experiences differentiate food security among African American adults.
        Nursing research. 2021; 70 (Suppl 1): S13-S20
        • Clark R.
        • Anderson N.B.
        • Clark V.R.
        • Williams D.R.
        Racism as a stressor for African Americans. A biopsychosocial model.
        The American psychologist. 1999; 54: 805-816
        • Collins F.S.
        • Mansoura M.K.
        The human genome project. Revealing the shared inheritance of all humankind.
        Cancer. 2001; 91 (Suppl): 221-225<221::Aid-cncr8>;2-0
        • David E.J.R.
        • Schroeder T.M.
        • Fernandez J.
        Internalized racism: A systematic review of the psychological literature on racism's most insidious consequence.
        Journal of Social Issues. 2019; 75: 1057-1086
        • Dougherty G.B.
        • Golden S.H.
        • Gross A.L.
        • Colantuoni E.
        • Dean L.T.
        Measuring structural racism and its association with BMI.
        American Journal of Preventive Medicine. 2020; 59: 530-537
        • Durkee M.I.
        • Gómez J.M.
        Mental health implications of the acting white accusation: The role of cultural betrayal and ethnic-racial identity among Black and Latina/o emerging adults.
        American Journal of Orthopsychiatry. 2021;
        • Duru O.K.
        • Harawa N.T.
        • Kermah D.
        • Norris K.C.
        Allostatic load burden and racial disparities in mortality.
        Journal of the National Medical Association. 2012; 104: 89-95
        • Engel G.L.
        The need for a new medical model: A challenge for biomedicine.
        Science. 1977; 196 (Available at:): 129-136
        • Gee G.C.
        • Hing A.
        • Mohammed S.
        • Tabor D.C.
        • Williams D.R.
        Racism and the life course: Taking time seriously.
        American Journal of Public Health. 2019; 109: S43-S47
        • Geronimus A.T.
        • Hicken M.
        • Keene D.
        • Bound J.
        “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States.
        American Journal of Public Health. 2006; 96: 826-833
        • Goetsch V.L.
        • Wiebe D.J.
        • Veltum L.G.
        • Van Dorsten B.
        Stress and blood glucose in type II diabetes mellitus.
        Behavior research and therapy. 1990; 28: 531-537
        • Griffith D.M.
        • Childs E.L.
        • Eng E.
        • Jeffries V.
        Racism in organizations: The case of a county public health department.
        Journal of Community Psychology. 2007; 35: 287-302
        • Gruenewald T.L.
        • Karlamangla A.S.
        • Hu P.
        • Stein-Merkin S.
        • Crandall C.
        • Koretz B.
        • Seeman T.E.
        History of socioeconomic disadvantage and allostatic load in later life.
        Social Science & Medicine. 2012; 74: 75-83
        • Hamilton D.
        • Darity W.
        • Price A.E.
        • Sridharan V.
        • Tippett R.
        Umbrellas don't make it rain: Why studying and working hard isn't enough for Black Americans.
        Insight Center for Community Economic Development Report. 2015; : 1-10
        • Hardeman R.
        • Chantarat T.
        • Karbeah J.
        Police exposure as a determinant of structural racism: An exploration of the association between preterm birth in neighborhoods with high police exposure.
        Health Services Research. 2020; 55 (50-50)
        • Hardeman R.R.
        • Homan P.A.
        • Chantarat T.
        • Davis B.A.
        • Brown T.H.
        Improving the measurement of structural racism to achieve antiracist health Policy.
        Health affairs (Project Hope). 2022; 41: 179-186
        • Harrell J.P.
        • Hall S.
        • Taliaferro J.
        Physiological responses to racism and discrimination: An assessment of the evidence.
        American Journal of Public Health. 2003; 93: 243-248
        • Harrell S.P.
        A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color.
        The American journal of orthopsychiatry. 2000; 70: 42-57
      2. Hersey, T. (2016). The nap ministry. Accessed on July 4, 2022, Available at:

        • Hudson D.
        • Sacks T.
        • Irani K.
        • Asher A.
        The price of the ticket: Health costs of upward mobility among African Americans.
        International Journal of Environmental Research and Public Health. 2020; 17: 1179
        • Incollingo Rodriguez A.C.
        • Polcari J.J.
        • Nephew B.C.
        • Harris R.
        • Zhang C.
        • Murgatroyd C.
        • Santos Jr H.P.
        Acculturative stress, telomere length, and postpartum depression in Latinx mothers.
        Journal of Psychiatric Research. 2022; 147: 301-306
        • Incollingo Rodriguez A.C.
        • Smith L.
        • Harris R.
        • Nephew B.C.
        • Santos Jr H.P.
        • Murgatroyd C.
        Oxytocin modulates sensitivity to acculturation and discrimination stress in pregnancy.
        Psychoneuroendocrinology. 2022; 141105769
        • Jones C.P.
        Levels of racism: A theoretic framework and a gardener's tale.
        American Journal of Public Health. 2000; 90: 1212-1215
        • LaFave S.E.
        • Bandeen-Roche K.
        • Gee G.
        • Thorpe R.J.
        • Li Q.
        • Crews D.
        • Szanton S.L.
        Quantifying older Black Americans' exposure to structural racial discrimination: How can we measure the water in which we swim?.
        Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2022; (doi:Advance online publication. 10.1007/s11524-022-00626-6)
        • Lara-Cinisomo S.
        • Girdler S.S.
        • Grewen K.
        • Meltzer-Brody S.
        A biopsychosocial conceptual framework of postpartum depression risk in immigrant and U.S.-born latina mothers in the United States.
        Women's Health Issues. 2016; 26: 336-343
        • Lavretsky H.
        • Newhouse P.A.
        Stress, inflammation, and aging.
        The American journal of geriatric psychiatry: Official journal of the American Association for Geriatric Psychiatry. 2012; 20: 729-733
        • Liu S.Y.
        • Fiorentini C.
        • Bailey Z.
        • Huynh M.
        • McVeigh K.
        • Kaplan D.
        Structural racism and severe maternal morbidity in New York State.
        Clinical Medicine Insights: Women's Health. 2019; 12: 1-8
        • Lu A.T.
        • Quach A.
        • Wilson J.G.
        • Reiner A.P.
        • Aviv A.
        • Raj K.
        • Horvath S.
        DNA methylation GrimAge strongly predicts lifespan and healthspan.
        Aging. 2019; 11: 303-327
        • Lu D.
        • Palmer J.R.
        • Rosenberg L.
        • Shields A.E.
        • Orr E.H.
        • DeVivo I.
        • Cozier Y.C.
        Perceived racism in relation to telomere length among African American women in the Black Women's Health Study.
        Annals of Epidemiology. 2019; 36: 33-39
        • Matthew D.B.
        Just Medicine: A Cure for Racial Inequality in American Health Care.
        NYU Press, 2018
        • McEwen B.S.
        Stress, adaptation, and disease: Allostasis and allostatic load.
        Annals of the New York Academy of Sciences. 1998; 840 (Available at:): 33-44
        • Miller H.N.
        • LaFave S.
        • Marineau L.
        • Stephens J.
        • Thorpe R.J.
        The impact of discrimination on allostatic load in adults: An integrative review of literature.
        Journal of Psychosomatic Research. 2021; 146: 1-11
        • Owens-Young J.
        • Bell C.N.
        Structural racial inequities in socioeconomic status, urban-rural classification, and infant mortality in US counties.
        Ethnicity & Disease. 2020; 30: 389-398
        • Palta P.
        • Szanton S.L.
        • Semba R.D.
        • Thorpe R.J.
        • Varadhan R.
        • Fried L.P.
        Financial strain is associated with increased oxidative stress levels: The Women's Health and Aging Studies.
        Geriatric Nursing. 2015; 36 (Suppl): S33-S37
        • Pohl D.J.
        • Seblova D.
        • Avila J.F.
        • Dorsman K.A.
        • Kulick E.R.
        • Casey J.A.
        • Manly J.
        Relationship between residential segregation, later-life cognition, and incident dementia across race/ethnicity.
        International Journal of Environmental Research and Public Health. 2021; 18: 11233
      3. racialization. (2022). Merriam-Webster.Com. Available at:

        • Redfield R.
        • Linton R.
        • Herskovits M.J.
        Memorandum for the study of acculturation.
        American Anthropologist. 1936; 38: 149-152
        • Robinson M.N.
        • Thomas Tobin C.S.
        Is John Henryism a health risk or resource?: Exploring the role of culturally relevant coping for physical and mental health among Black Americans.
        Journal of Health and Social Behavior. 2021; 62: 136-151
        • Rothstein Richard.
        The Color of Law.
        Liveright Publishing Corporation, New York, NY2018
      4. Savage, N. (2021). ‘We said no’: Los Angeles officers storm Black couple's home hours after they refused a blood draw for their newborn daughter following a home birth. Atlanta Black Star. Available at:

        • Selye H.
        The General-Adaptation-Syndrome.
        Annual Review of Medicine. 1951; 2: 327-342
        • Sluiter F.
        • Incollingo Rodriguez A.C.
        • Nephew B.C.
        • Cali R.
        • Murgatroyd C.
        • Santos H.P.
        Pregnancy associated epigenetic markers of inflammation predict depression and anxiety symptoms in response to discrimination.
        Neurobiology of Stress. 2020; 13100273
        • Smedley A.
        Race in North America: Origin and Evolution of a Worldview.
        2nd ed. Westview Press, 1999 (Available at:)
        • Smedley A.
        • Smedley B.D.
        Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race.
        The American Psychologist. 2005; 60: 16-26
        • Villeneuve L.M.
        • Reddy M.A.
        • Natarajan R.
        Epigenetics: Deciphering its role in diabetes and its chronic complications.
        Clinical and Experimental Pharmacology and Physiology. 2011; 38: 451-459
        • Wade D.T.
        • Halligan P.W.
        The biopsychosocial model of illness: A model whose time has come.
        Clinical Rehabilitation. 2017; 31: 995-1004
        • Wallace M.E.
        • Mendola P.
        • Liu D.
        • Grantz K.L.
        Joint effects of structural racism and income inequality on small-for-gestational-age birth.
        American Journal of Public Health. 2015; 105: 1681-1688
        • Zinn H.
        A People's History of the United States.
        Harper & Row, 1990