Introduction

Compared to other racial and ethnic groups, Black Americans are affected disproportionately by poor health. Despite some improvements in health over the last 30 years, health disparities for Blacks are still evident across varying health outcomes including, but not limited to, higher rates of hypertension, stroke, heart disease, obesity, diabetes, HIV infection, and self-rated health (SRH) (Cagney et al. 2005; Kirk et al. 2006; Mensah et al. 2005; Centers for Disease Control and Prevention (CDC) 2008, 2011; Ljungvall and Zimmerman 2012). One promising line of research that has shed light on how group differences arise in health outcomes has focused on experiences of racial discrimination. This research shows that Blacks report significantly higher levels of discrimination compared to other groups and that these experiences of discrimination have adverse effects on mental and physical health (Williams and Mohammed 2003, 2009; Paradies 2006).

In this study, we extend the research on racial discrimination and health by investigating whether racial group identity—the extent to which individuals positively identify with others of their racial group—reduces or buffers the harmful effects of discrimination. In existing studies, racial group identity is conceptualized as a psychosocial resource that may lessen the injurious impact of discrimination (see e.g., Ida and Christie-Mizell 2012). Additionally, we consider variation among Black Americans by examining whether the relationships among SRH, discrimination, and racial group identity differ by ethnicity.

This study improves on current research in two important ways. First, we utilize nationally representative data for the U.S. Black population. Many studies in this area have engaged more localized samples—therefore, curtailing the ability to generalize to the larger population. Second, we assess ethnic heterogeneity and the impact of nativity among Black Americans. One reasonable critique of the current literature on Blacks and health outcomes is that relatively little is known about intragroup variation (Williams and Jackson 2000; Ida and Christie-Mizell 2012; Dagadu and Christie-Mizell 2014). For example, ethnic heterogeneity and nativity may simultaneously shape health outcomes and be related to varying levels of racial group identity and perceptions of discrimination. To redress this gap in the literature, we consider outcomes for three groups: African Americans, foreign-born Caribbean Blacks, and U.S.-born Caribbean Blacks.

Theoretical Background

The theoretical basis for this research is the stress process model (Pearlin et al. 1981), which posits that the observed differences in health arise out of the social context of people’s lives and are impacted by an individual’s history and current circumstances (see also Dagadu and Christie-Mizell 2014; Turner 2010). This framework focuses on interrelationships in three domains: stressors, moderators, and outcomes. Stressors include events, circumstances, or conditions that inhibit the individual’s adaptive capability (Christie-Mizell et al. 2008; Pearlin et al. 1981; Turner 2010). Further, stressors not only are linked to non-productive coping and intrapsychic distress but also can cause the dysregulation of the body’s physiological systems—which, in turn, can lead to illness and premature mortality (Geronimus et al. 2011; Williams and Mohammed 2009). For example, Révész et al. (2014) find that high levels of stress were associated with higher heart rates, respiratory sinus arrhythmia, and inflammation of the immune system—factors associated with accelerated biological aging and other markers of poor health. Racial discrimination, in the form of major lifetime discrimination and day-to-day discrimination (see e.g., Williams and Mohammed 2003), is the main stressor examined here.

Moderators are psychosocial resources (e.g., racial group identity) that attenuate the damaging impact of stressors by boosting the individual’s ability to cope with distress (Turner 2010). The types and levels of psychosocial resources arise out of individual’s social positions and the presence of these moderators accounts for some of the variation in health outcomes across status groups (e.g., race-ethnicity, gender, social class) (Turner and Avison 2003). Racial group identity is the main moderator that we consider in this study and is measured as closeness to other Blacks and positive Black group evaluation (Ida and Christie-Mizell 2012). Outcomes, the final part of the stress process, are the observed effects of stressors after accounting for the moderating process (see e.g., Dagadu and Christie-Mizell 2014). SRH is our outcome of interest.

Self-Rated Health, Discrimination, and Racial Group Identity

SRH is a subjective measure of general health that reflects both physical and emotional dimensions of well-being (DeSalvo et al. 2006; Nakata et al. 2010). Many studies show that SRH provides a reliable assessment of current illness, prior health history, future health prospects, and mortality, independent of medical, sociodemographic, behavioral, and psychosocial factors (Benjamins et al. 2004; Benyamini et al. 2003; Idler et al. 2004; Miller and Wolinsky 2007; Walker et al. 2004). Self-ratings of health reliably predict survival across various racial and ethnic groups, and the associations between SRH and clinical measures of health are highly robust and have been replicated across countries, racial-ethnic groups, and gender (Benyamini et al. 2003; Chandola and Jenkinson 2000; Heidrich et al. 2002; Perlman and Babok 2008).

In the current study, we consider both major and day-to-day discrimination. Major discrimination refers to events that interfere with one’s socioeconomic mobility and life chances (e.g., unfairly denied a job promotion or abused by the police) (Dagadu and Christie-Mizell 2014; Williams and Mohammed 2003). Alternately, day-to-day discrimination reflects the interpersonal discrimination that occurs in daily interactions such as being treated with less respect in public or receiving poor service at a store (Taylor and Turner 2002). Williams and Mohammed (2003) in a review of population-based studies on discrimination and health state that “evidence suggests that perceived discrimination is an important though understudied race-related stressor that may adversely affect health” (p. 202). Racial discrimination as a source of distress is connected to ill health through structural (e.g., blocking employment opportunities), interpersonal (e.g., depleting personal sense of mastery), and biological (i.e., influencing immune system, cellular aging, and gene expression) pathways (Blackburn-Munro and Blackburn-Munro 2001; Chae et al. 2010). These adverse health effects associated with discrimination are experienced across multiple health outcomes, including SRH (Moody et al. 2014; Bratter and Gorman 2011; Karlsen and Nazroo 2002; Schulz et al. 2006).

A central goal of this research is to assess whether and how racial group identity, the extent to which an individual positively identifies with his or her racial or ethnic group, reduces the deleterious effects of discrimination on SRH (Dagadu and Christie-Mizell 2014; Mossakowski 2003). The development of racial group identity involves the understanding of the position of one’s group in the larger society and “positive racial group identity connects individuals to meaningful roles and purpose inside their families and communities, which [promote health] … despite the stressors associated with minority status” (Ida and Christie-Mizell 2012, p. 44). That is, racial group identity has been found to be one facet of the Black experience that buffers individuals from the deleterious effects of discrimination (Dagadu and Christie-Mizell 2014; Mossakowski 2003; Sellers et al. 2003; Wong et al. 2003). For our purposes, we borrow from existing research and conceptualize racial group identity as closeness to other Blacks and Black group evaluation (Hughes et al. 2015). Closeness to other Blacks captures an individual’s level of feelings of understanding and intimacy with other Blacks, whereas Black group evaluation is indicative of an overall appraisal ranging from negative to positive views of Blacks as a group (Hughes et al. 2015; Ida and Christie-Mizell 2012).

Variation by Ethnicity and Nativity

In recent decades, the Black population in the U.S. has rapidly grown due in large part to immigration patterns from the Caribbean and Africa. Caribbean Blacks represent the largest proportion of Black immigrants, totaling about 4% of the Black population or around 1.5 million people (Brown 2015). Nevertheless, despite ethnic differences between African Americans and Caribbean Blacks stemming from national origin and immigration patterns, less research has given attention to how this variation may impact the relationships among health, stressors, and identity for these two groups (Chatters et al. 2008; Dagadu and Christie-Mizell 2014). That is, these two groups tend to be identified in research as one racial group (i.e., Black Americans) without regard to ethnicity or nativity. Certainly, there are similarities in the African American and Caribbean Black experience, including a history of enslavement and oppression (Logan 2007). However, past research highlights several key distinctions between these subpopulations, including socioeconomic differences, concentrations in various parts of the country (e.g., the Northeast versus the South), and health differentials (Hunt et al. 2012; U.S. Census Bureau 2011; Logan 2007).

Differences between African Americans and Caribbean Blacks are shaped by both ethnicity and nativity. For instance, driven by patterns of immigration among foreign-born Caribbean Blacks, this group is more likely to be concentrated in urban areas of the northern U.S. compared to their African American counterparts (Rodriguez 2002). Conversely, because of historical patterns of residence and reverse migration in recent decades, the majority of African Americans live in the southern region of the U.S. (Kent 2007; Nazroo et al. 2007; Hunt et al. 2012; U.S. Census Bureau 2011). Other research shows that Caribbean Blacks are more likely to have higher income, education, and employment rates than African Americans (Aguirre and Turner 2004; Logan 2007; Rodriguez 2002). Furthermore, compared to their African American counterparts, those of Caribbean descent are healthier, have longer life expectancy, and have higher rates of marriage (Kent 2007; Nazroo et al. 2007).

Summary and Hypotheses

This research study examines the relationships among discrimination, racial group identity, and SRH. In the models developed below, we operationalize discrimination as a stressor that may impact health and racial group identity as a psychosocial resource that may act as a buffer between discrimination and health.

Hypotheses

  • H1: Major discrimination will be negatively associated with SRH.

  • H2: Day-to-day discrimination will be negatively associated with SRH.

  • H3a–b: The impact of major discrimination on SRH will be moderated by (a) closeness to other Blacks and (b) Black group evaluation; such that these forms of racial group identity will reduce the negative association between SRH and major discrimination.

  • H4a–b: The impact of day-to-day discrimination on SRH will be moderated by (a) closeness to other Blacks and (b) Black group evaluation; such that these forms of racial group identity will reduce the negative association between SRH and day-to-day discrimination.

To explore the impact of ethnic heterogeneity and nativity among Black Americans, we test these hypotheses in the context of three groups: African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Further, we control for several factors that prior research has shown to be associated with SRH, discrimination, and racial group identity. These factors include mastery, self-esteem, family support, religiosity, marriage, family size, urban residence, region, income, education, employment, and age.

Data and Methods

The analyses for this paper utilize data from the National Survey of American Life (NSAL). The NSAL is a nationally representative multistage probability sample of 3570 African Americans, 1621 Blacks of Caribbean descent (Caribbean Blacks), and 891 non-Hispanic Whites (living in areas where at least 10% of the population is Black), with an age range of 18 to 99 years (Jackson et al. 2004). For the NSAL, interviews were conducted with non-institutionalized individuals, and researchers identified African Americans as those who identify as Black but do not claim ancestral ties to the Caribbean. Conversely, Caribbean Blacks were categorized as those who identify as Black and claim ancestral ties to the Caribbean. These data were collected between February 2001 and March 2003 and had an overall response rate of 72.3% (Jackson et al. 2004). In this study, we restrict our sample to African Americans and Caribbean Blacks, because Whites were not queried about Black racial group identity. The subsample derived for this study totals 4091 respondents (2960 African Americans, 311 U.S-born Caribbean Blacks, and 820 foreign-born Caribbean Blacks). All analyses presented below are weighted to correct for the complex sampling design of NSAL.

Measures

SRH is the dependent variable for this study and is measured by a single item which asks each respondent to rate his or her overall physical health, ranging from 1 (poor) to 5 (excellent). Major lifetime discrimination and day-to-day discrimination are the key independent variables. Major discrimination is measured by a nine-item count and asks each respondent whether he or she has ever been (1) unfairly fired; (2) not hired for unfair reasons; (3) unfairly denied promotion; (4) unfairly treated/abused by police; (5) discouraged unfairly by a teacher from continuing education; (6) prevented unfairly from moving into a neighborhood because the landlord or realtor refused to sell a house or apartment; (7) life was made difficult by neighbors; (8) unfairly denied a loan; and (9) received service from someone such as a plumber or car mechanic that was worse than what others get. Responses are coded 1 for yes and 0 for no and then summed to create a count of that ranges from 0 (lower exposure to major discrimination) to 9 (higher exposure to major discrimination).

Day-to-day discrimination is measured by ten items with responses ranging from 0 (never) to 5 (almost every day). The 10 items include (1) treated with less courtesy than other people; (2) treated with less respect than other people; (3) people act like the respondent is not smart; (4) receives poorer service than other people at restaurants and stores; (5) people act as if they are afraid of the respondent; (6) people act as if the respondent is dishonest; (7) people act as if they are better than the respondent; (8) called names or insulted; (9) threatened or harassed; and (10) followed in stores. Responses for each of the items are summed and divided by the number of items to create a measure of day-to-day discrimination that ranges from 0 (lower discrimination) to 5 (higher discrimination). The alpha reliabilities are quite high for African Americans (.88), U.S.-born Caribbean Blacks (.88), and foreign-born Caribbean Blacks (.91).

In this study, we use two measures of racial group identity, closeness to other Blacks and Black group evaluation as moderators of discrimination (Hughes et al. 2015). Closeness to other Blacks is measured as an eight-item scale. Respondents are asked about their closeness in ideas or feelings to Black people who are (1) poor; (2) religious church-going; (3) young; (4) upper class; (5) working class; (6) older; (7) elected officials; (8) and doctors, lawyers, or other professional people. The items are summed and divided by the number of items and yields a measure that ranges from 1 (lower closeness) to 4 (higher closeness). The alpha reliabilities for African Americans (.87), U.S.-born Caribbean Blacks (.83), and foreign-born Caribbean Blacks (.88) are suitably high. Black group evaluation is measured by six items, in which respondents were asked how true they think it is that most Black people are (1) intelligent; (2) lazy; (3) hard-working; (4) give up easily; (5) proud of themselves; and (6) violent. These six items range from 1 (very true) to 4 (not true at all) and are summed and coded to range from 1 (less positive evaluation) to 4 (more positive evaluation). The alpha is .62 for African Americans and .65 for both U.S.-born and foreign-born Caribbean Blacks.

Control Variables

Mastery is measured using the Pearlin Mastery Scale (Pearlin 1989). Respondents are asked their level of agreement (1 (strongly agree) to 4 (strongly disagree)) with the following items: (1) there is really no way I can solve some of the problems I have; (2) sometimes I feel that I’m being pushed around in life; (3) I have little control over the things that happen to me; (4) I can do just about anything I set my mind to; (5) I often feel helpless in dealing with the problems of life; (6) what happens to me in the future depends on me; and (7) there is little I can do to change many of the important things in my life. These items are summed, divided by the number of items, and coded to create a scale ranging from 1 (lower mastery) to 4 (higher mastery). The alpha estimates are .72, .82, and .76 for African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks, respectively.

Self-esteem is measured by the ten-item Rosenberg self-esteem scale (Rosenberg 1965), which has been validated for Black populations (see e.g., Holt et al. 2014). The scale has items that ask respondents to rate their level of agreement from 1 (strongly agree) to 4 (strongly disagree) for the following prompts: (1) I am person of worth/equal to others; (2) I have number of good qualities; (3) I am a failure; (4) I do things as well as others; (5) I do not have much to be proud of; (6) I take a positive attitude toward myself; (7) I am satisfied with myself; (8) I want more self-respect; (9) I sometimes feel useless; and (10) I sometimes think I am no good. These items are summed and divided by the number of items. When necessary items were reverse coded, the result is a scale that ranges from 1 (lower self-esteem) to 4 (higher self-esteem). The alpha reliabilities are .76 for African Americans, .77 for U.S.-born Caribbean Blacks, and .84 for foreign-born Caribbean Blacks.

Social support is operationalized as received emotional support from family members (Fetzer Institute and National Aging Working Group 1999). This three-item scale measures perceived social support received from family members. It asks respondents to report how frequently family members (1) make him/her feel loved and cared for; (2) listen to him/her talk about his/her problems and concerns; and (3) express interest and concern in his/her well-being. These items are summed, divided by the number of items, and coded to create a scale from 1 (lower social support) to 4 (higher social support). The alpha reliabilities are .74 for African Americans, .82 for U.S.-born Caribbean Blacks, and .70 for foreign-born Caribbean Blacks.

Other control variables include religiosity, which refers to the frequency of attending religious services, ranging from 1 (less than once a year) to 5 (four or more times a week). Age is measured in years, while gender is coded 1 for female and compared to males (coded 0). Models also incorporate education (years), household income (thousands of dollars), and employment status (1 = employed, compared to those not working). We also compare those married or cohabitating (1 = yes) to those who are separated, divorced, widowed, or never married. Further, family size is operationalized as the number of dependent children (count) in the household. Finally, we account for rural residence (1 = yes) compared to urban dwelling and southern residence (1 = yes) compared to living in other regions of the country.

Analytic Strategy

We proceeded with the analyses for this project in three steps. Initially, we generated descriptive statistics for all the study variables, comparing means and percentages across our three subsamples. In the next step, we estimate a series of additive regression models, including four models. The first, baseline model regresses SRH on all demographic and socioeconomic variables. The second model adds major and day-to-day discrimination, followed by the integration of interpersonal resources and racial group identity in the third model. This modeling strategy allows for the assessment of the impact of discrimination on SRH with and without other important covariates. Our final step in the analyses is to test through interactions whether racial group identity reduces the impact of discrimination on SRH.

For the multivariate analyses below, we estimate linear regressions, utilizing techniques to account for the complex design of the data. In our models, we produce robust standard errors that account for the clustered and stratified sampling used to collect the data (Jackson et al. 2004). We estimated and verified the models we present below in several ways. In addition to multiple linear regression, we also calculated logistic regression (where SRH was dichotomized into good (1 = combining good, very good and excellent) and poor (0 = combining fair and poor)), ordered logistic regression, and a version of the linear regression taking the natural log of SRH. Across these methods, our findings do not differ substantially. The stability of our findings is likely because our measure of SRH comes from representative data, approximates well a normal distribution, and respondents represent an age range from 18 to 94 years old (rather than a younger or an older population) (Aiken-Morgan et al. 2014; Kravitz-Wirtz 2016; Min 2013).

Results

Descriptive Findings

Table 1 displays the descriptive findings. Both African Americans (\( \overline{x} \) = 3.41) and U.S.-born Caribbean Blacks (\( \overline{x} \) = 3.42) report significantly lower SRH, compared to foreign-born Caribbean Blacks (\( \overline{x} \) = 3.67). With respect to major discrimination, African Americans (\( \overline{x} \) = 1.36) report significantly higher major discrimination than foreign-born Caribbean Blacks (\( \overline{x} \) = 1.01), but significantly lower major discrimination than U.S.-born Caribbean Blacks (\( \overline{x} \) = 1.77). Furthermore, the major discrimination reported by U.S.-born Caribbean Blacks is significantly higher than that reported by foreign-born Caribbean Blacks. U.S.-born Caribbean Blacks (\( \overline{x} \) = 1.48) report significantly higher day-to-day discrimination than their African American (\( \overline{x} \) = 1.22) and foreign-born Caribbean Black counterparts (\( \overline{x} \) = 1.06).

Table 1 Weighted means, percentages, standard deviations (SD), and for all study variables, (N = 4091)
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Turning to racial group identity, African Americans (\( \overline{x} \) = 3.25) report significantly higher closeness to other Blacks compared to both U.S.-born Caribbean Blacks (\( \overline{x} \)= 3.10) and foreign-born Caribbean Blacks (\( \overline{x} \) = 3.12). Black group evaluation is more positive among U.S.-born Caribbean Blacks (\( \overline{x} \) = 3.27), compared to African Americans (\( \overline{x} \) = 3.18) and foreign-born Caribbean Blacks’ (\( \overline{x} \) = 3.20).

In terms of the other important psychosocial resources, African Americans (\( \overline{x} \) = 3.34) and U.S.-born Caribbean Blacks (\( \overline{x} \) = 3.37) report higher mastery than foreign-born Caribbean Blacks (\( \overline{x} \) = 3.19). There are no differences in the mastery of African Americans and U.S.-born Caribbean Blacks. U.S.-born Caribbean Blacks (\( \overline{x} \) = 3.69) have higher self-esteem than African Americans (\( \overline{x} \) = 3.62) and foreign-born Caribbean Blacks (\( \overline{x} \) = 3.62). African Americans and foreign-born Caribbean Blacks do not differ on self-esteem. All three groups report similar levels of social support—African Americans (\( \overline{x} \) = 3.26), U.S.-born Caribbean Blacks (\( \overline{x} \) = 3.27), and foreign-born Caribbean Blacks (\( \overline{x} \) = 3.20). While there is no difference in the frequency of church attendance between African Americans (\( \overline{x} \) = 3.10) and foreign-born Caribbean Blacks (\( \overline{x} \) = 3.09), both groups have higher frequency of attendance than U.S.-born Caribbean Blacks (\( \overline{x} \) = 2.69).

With respect to demographic and socioeconomic status, U.S.-born Caribbean Blacks (\( \overline{x} \) = 13.64) have significantly higher education than African Americans (\( \overline{x} \) = 12.44) and foreign-born Caribbean Blacks (\( \overline{x} \) = 13.00). In turn, foreign-born Caribbean Blacks have higher educational attainment than African Americans. Further, African Americans (\( \overline{x} \) = 32.43) have lower household income than both U.S.-born Caribbean Blacks (\( \overline{x} \) = 46.16) and foreign-born Caribbean Blacks (\( \overline{x} \) = 40.71). There are no significant differences in household income between foreign-born Caribbean Blacks and U.S.-born Caribbean Blacks. In the multivariate analyses presented below, household income is logged to correct for a skewed distribution. In terms of employment, Africans Americans (67.06%) are significantly less likely to be employed than both their U.S.-born Caribbean Black (74.28%) and their foreign-born Caribbean Black (75.85%) counterparts. There is no difference in the percentage of those employed in the U.S-born Caribbean Black and foreign-born Caribbean Black subsamples.

There are no significant differences in the number of dependent children in the households of the three subsamples, with a mean of .57 for African Americans and .52 for both U.S.-born Caribbean Blacks and foreign-born Blacks. There are no differences in the percentages of women across the three subsamples. The percentage of women is 65.34, 62.70, and 62.56% for African Americans, U.S.-born Caribbean Blacks, and foreign-born Blacks, respectively. Also, there are no age differences between African Americans (\( \overline{x} \) = 43.00 years) and foreign-born Caribbean Blacks (\( \overline{x} \) = 42.64 years). However, both the African American and foreign-born Caribbean Black subsamples are older than the U.S.-born Caribbean Black subsample (\( \overline{x} \) = 38.88 years). The foreign-born Caribbean Black subsample (45.85%) has a higher percentage of married individuals than the African American (35.57%) and the U.S.-born Caribbean Black (36.33%) subsamples. More African Americans (66.72%) than U.S.-born Caribbean Blacks (24.44%) or foreign-born Caribbean Blacks (31.34%) reside in the southern region of the U.S. Further, a higher percentage of foreign-born Caribbean Blacks are from the South than U.S.-born Caribbean Blacks. Finally, a higher percentage of African Americans (39.59%) reside in rural areas/small towns than both U.S.-born Caribbean Blacks (9.00%) and foreign-born Caribbean Blacks (34.39%). The percentage of foreign-born Caribbean Blacks, who reside in the South, is higher than the percentage of U.S.-born Caribbean Blacks.

Multivariate Findings

In Table 2, model 1 shows our baseline model, including demographic and socioeconomic variables. This model shows that foreign-born Caribbean Blacks report higher levels of SRH than their African American counterparts. Both women and the aged report poorer SRH, while employment, education, income, and southern residence are positively associated with health. In model 2, we add major discrimination and day-to-day discrimination to our estimations and find that both are negatively associated with SRH. For the most part, the introduction of the discrimination variables to the model does little to change the pattern of effects established in the first model. In this second model, female gender and aging are negatively associated with SRH, with foreign-born Caribbean ethnicity, employment, education, and income showing a positive association with health. However, unlike the prior equation, there is a non-significant effect of southern residence.

Table 2 Self-rated health regressed on selected variables. National Survey of American Life (N = 4091)
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In Table 2, model 3, we incorporate interpersonal resources into our estimation and find that both mastery and self-esteem increase SRH, while neither of our racial group identity measures, closeness, nor group evaluation is significant. In this third model, major discrimination remains significant, while day-to-day discrimination is no longer significant. There are two patterns that emerge in this model that were not seen in the prior model. First, U.S.-born Caribbean Blacks report worse SRH than their African American counterparts. Second, rural residence is now connected to better health. In terms of other variables in the model 3, foreign-born Caribbean Blacks continue to report higher levels of SRH than African Americans. Also, employment and education remain positively associated with SRH, while being a woman and aging are inversely related to health. Despite our failure to find main effects of racial group identity, we still test our contention that racial group identity may have the ability to buffer the effects of discrimination on SRH. These results are shown Tables 3 and 4.

Table 3 Self-rated health regressed on interactions by major discrimination, ethnicity, and nativity. National Survey of American Life (N = 4091)
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Table 4 Self-rated health regressed on interactions by day-to-day discrimination, ethnicity, and nativity. National Survey of American Life (N = 4091)
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In Table 3, we explore whether racial group identity moderates the impact of major discrimination by ethnicity (African American versus Caribbean Black) and nativity (U.S.-born versus foreign born). Model 1 shows the results for whether closeness to other Blacks reduces the impact of major discrimination on SRH. For U.S.-born Caribbean Blacks (b = .082, p < .05), closeness to other Blacks is less effective at certain levels of major discrimination in reducing the impact of discrimination on SRH, compared to their African American counterparts. Figure 1 graphically displays this interaction. The pattern of findings is not shown for foreign-born Caribbean Blacks, given that their outcomes do not differ from African Americans.

Fig. 1
figure 1

The relationships among ethnicity, nativity, major discrimination, closeness to other Blacks, and self-rated health. Foreign-born Caribbean Blacks are not depicted above because they do not differ significantly from African Americans

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Lines 1 and 3 of Fig. 1 represent high discrimination for U.S.-born Caribbean Blacks and African Americans, respectively. At low levels of closeness to other Blacks, U.S.-born Caribbean Blacks start at lower SRH than their African American counterparts. As closeness to other Blacks increases, U.S.-born Caribbean Blacks experience a steeper incline in good health, compared to African Americans. In fact, the slight increase for African Americans represented by line 3 is not significant (t = 1.09, p = .28). At the highest levels of closeness to other Blacks, U.S.-born Caribbean Blacks receive a boost to SRH that puts them on par with African Americans.

In Fig. 1, lines 2 and 4 represent outcomes for low discrimination for U.S.-born Caribbean Blacks and African Americans, correspondingly. The graph (line 2) shows that U.S. Caribbean Blacks, who experience low discrimination, experience declining health as levels of closeness to other Blacks increases. Alternatively, African Americans who experience low discrimination have better health at both low and high levels of closeness to other Blacks than any other group (Fig. 1, line 4). However, the very slight increase in health experienced by this group is not significant (t = 1.53, p = .14).

In Table 3, model 2 shows the results for whether Black group evaluation moderates the impact of major discrimination on SRH. The findings suggest that for foreign-born Caribbean Blacks, the detrimental impact of major discrimination on SRH is lessened (b = − .179, p < .05) by Black group evaluation, compared to African Americans. However, as displayed in Fig. 2, these findings vary not only across ethnicity and nativity but also across levels of discrimination. Results are not diagrammed for U.S.-born Caribbean Blacks in this case, because their outcomes do not differ from African Americans.

Fig. 2
figure 2

The relationships among ethnicity, nativity, major discrimination, Black group evaluation, and self-rated health. U.S.-born Caribbean Blacks are not depicted above because they do not differ significantly from African Americans

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Lines 1 and 3 of Fig. 2 show results for foreign-born Caribbean Blacks and African Americans, who reported high major discrimination, respectively. Foreign-born Caribbean Blacks (Fig. 2, line 1) have the highest SRH compared to African Americans and low discrimination for foreign-born Caribbean Blacks. However, for this particular group (i.e., foreign-born Caribbean Black), Black group evaluation does not modify the effects of high discrimination on SRH (t = .20). African Americans, who experience high levels of major discrimination (Fig. 2, line 3), start at the lowest levels of SRH compared to any other group in Fig. 2. However, SRH significantly rises as Black group evaluation increases for this group. Nevertheless, this group, even at the highest levels of Black group evaluation, still has among the lowest levels of SRH.

Foreign-born Caribbean Blacks, who reported low major discrimination, are represented by line 2 in Fig. 2. This group experiences the greatest increase in health as Black group evaluation increases. In fact, at the highest levels of Black group evaluation, they have the highest SRH, not significantly different than high discrimination foreign-born Caribbean Blacks as mentioned above. Alternatively, African Americans, who experience low major discrimination, are shown by line 4 in Fig. 2 and they receive no health benefit associated with Black group evaluation (t = − .36, p = .72).

In Table 4, model 1 shows that closeness to other Blacks does not moderate the impact of day-to-day discrimination on SRH and that this pattern does not differ by ethnicity or nativity. However, Table 4, model 2 does show that Black group evaluation modifies the impact of day-to-day discrimination on SRH, foreign-born Caribbean Blacks faring better than African Americans. As graphically displayed in Fig. 3, these findings vary by ethnicity, nativity, and levels of discrimination. Results are diagrammed for foreign-born Caribbean Blacks and African Americans, but not for U.S.-born Caribbean Blacks, because they do not differ from African Americans.

Fig. 3
figure 3

The relationships among ethnicity, nativity, day-to-day discrimination, Black group evaluation, and self-rated health. U.S.-born Caribbean Blacks are not depicted above because they do not differ significantly from African Americans

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Lines 1 and 3 in Fig. 3 represent foreign-born Caribbean Blacks and African Americans, who experience high day-to-day discrimination. For both groups, Black group evaluation weakens the other deleterious impact of day-to-day discrimination. Namely, SRH increases for both groups as Black group evaluation increases and becomes more positive. However, the increase for foreign-born Caribbean Blacks (Fig. 3, line 1) is much steeper than for African Americans (Fig. 3, line 3). For foreign-born Caribbean Blacks (Fig. 3, line 2) and African Americans (Fig. 3, line 4) who experience low levels of discrimination, Black group evaluation does not moderate the effects of discrimination on SRH. However, foreign-born Caribbean Blacks do have higher SRH than African American counterparts, regardless of the levels of Black group evaluation or discrimination.

Discussion

In this study, we examined how ethnic heterogeneity and nativity among Black Americans shape the relationships among SRH, discrimination, and racial group identity. First, we first sought to understand the impact of major discrimination and day-to-day discrimination on SRH. Second, we tested whether racial group identity changes the impact of discrimination on SRH and whether there was variation in this pattern for African Americans, compared to U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks.

H1 predicted that major discrimination would be negatively associated with SRH. This hypothesis is supported as major discrimination significantly decreased SRH. Similarly, H2 proposed that day-to-day discrimination would be negatively associated with SRH. This hypothesis was not supported. With respect to health, these findings indicate that major discrimination (e.g., not hired for unfair reasons or unfairly treated/abused by police) has a much more deleterious impact on physical health compared to day-to-day discrimination.

In our third hypothesis, we anticipated that the impact of major discrimination on SRH would be modified by closeness to other Blacks (H3a) and Black group evaluation (H3b), such that these forms of racial group identity would reduce the negative association between SRH and major discrimination. We found support for H3a among U.S.-born Caribbean Blacks who reported experiencing high levels of discrimination. For this group, as closeness to other Blacks increases, SRH steeply inclines, despite high levels of discrimination. As hypothesized, closeness to other Blacks weakens the damaging impact of discrimination on health. Racial group identity in the form of closeness to other Blacks is an interpersonal resource that benefits health by dampening the effect of discrimination on SRH.

Curiously and contrary to our hypothesizing, U.S.-born Caribbean Blacks who reported low major discrimination experienced a decline in health as closeness to other Blacks increased. This seemingly paradox (i.e., worse health in the face of low discrimination and high closeness) may actually be explained by the high levels of closeness, which means that the individual is most likely intimately involved in the lives of other Blacks, a group who, on average, face more discrimination than any other race-ethnic group (see e.g., Bratter and Gorman 2011). Therefore, even if the individual is not experiencing high levels of discrimination, by virtue of proximity to other Blacks, the person may experience vicarious distress and as a result worse health (Darity et al. 2003; Gee 2011; Grynberg et al. 2012). Put another way, under the circumstances that U.S.-born Caribbean Blacks are close to other Blacks, they may be especially susceptible to empathizing with negative experiences of other Blacks which might harm health through distress and stress reactions (Grynberg et al. 2012).

H3b proposed that that impact of major discrimination on SRH is moderated by Black group evaluation. We found support for this hypothesis among foreign-born Caribbean Blacks, who reported low levels of discrimination and among African Americans, who experienced high levels of discrimination. For the latter group, African Americans with high discrimination, as levels of Black group evaluation increases so too does SRH. As theorized, Black group evaluation inhibits the injurious impact of discrimination on health. This pattern of findings also applies to U.S.-born Caribbean Blacks, who did not differ significantly from African Americans. With respect to foreign-born Caribbean Blacks, Black group evaluation improves mental health for those who experience low levels of discrimination rather than those who reported high levels of discrimination. From low to high levels of Black group evaluation, SRH improves by .424 of a unit, which is more than a third of a standard deviation. Foreign-born Caribbean Blacks, who experience low discrimination and have positive experiences with and evaluations of other Blacks, experience less distress. In turn, lower stress leads to better health outcomes.

In our fourth hypothesis, we predicted that the influence of day-to-day discrimination on SRH would be moderated by closeness to other Blacks (H4a) and Black group evaluation (H4b). We expected that closeness and evaluation would diminish the impact of day-to-day discrimination on SRH. We did not find support for H4a, because closeness to other Blacks did not moderate the effects of day-to-day discrimination on SRH for any of the groups in our study. However, we did find support for H4b. For both foreign-born Caribbean Blacks and African Americans, who experience high discrimination, Black group evaluations weakens the influence of day-to-day discrimination of SRH. These results support the contention of the stress process model, which posits that interpersonal resources such as racial group identity will lessen the impact of stressors on health. The improvement in health is greater for foreign-born Caribbean Blacks, who start with better health even at low levels of Black group evaluation, than their African American counterparts. The findings reported here for H4b are the same for African Americans and U.S.-born Caribbean Blacks.

Conclusions

This study contributes to our understanding of how ethnic heterogeneity and racial group identity matter among Black Americans for health. Our study shows that racial group identity not only operates differently by ethnicity but also by nativity. We anticipated four instances in which racial group identity would matter for changing the effects of discrimination on health and found noteworthy patterns in three of those cases. In two of these instances ((1) evaluation × major discrimination and (2) evaluation × day-to-day discrimination), the results were different for foreign-born Caribbean Blacks compared to African Americans and U.S.-born Caribbean Blacks. The fact that African Americans and U.S.-born Caribbean have the same outcomes more often than not suggests that experiencing life as Black people in the U.S. homogenizes their experience and standardizes how Black group evaluation modifies the effects of major discrimination and day-to-day discrimination on health. Despite different ethnicity, African Americans and U.S.-born Caribbean Blacks start at equivalent levels of SRH, and the process connecting Black group evaluation and discrimination to health is comparable.

In the third case (closeness × major discrimination) of how racial group identity alters the influence of discrimination on SRH, the results were the same for African Americans and foreign-born Caribbean Blacks, but different for U.S. Caribbean Blacks. Recall that closeness to other Blacks benefitted the SRH of U.S.-born Caribbean Blacks, who experience high levels of discrimination, but weakened the health of U.S.-born Caribbean Blacks, who reported low levels of discrimination. What is striking about our results is that under no constellation of the interactions tested are U.S.-born Caribbean Blacks and foreign-born Blacks similar. This finding highlights the importance of nativity. The fact that closeness is helpful under one condition but unhelpful in another for U.S.-born Caribbean Blacks shows the importance of nativity, which shapes experiences that lead to health outcomes (cf. Thornton et al. 2012).

Beyond the specifics of our study, this work has two broader and important implications. First, the information found here provides a further basis for understanding the disadvantage that Black populations in the U.S. face with respect to health (Chae et al. 2010; Read and Emerson 2005). Among all racial and ethnic groups in the U.S., Blacks have the highest morbidity and mortality for almost all diseases and have higher rates of disabilities and shorter life spans (Chae et al. 2010; Dagadu and Christie-Mizell 2014; Read and Emerson 2005). In other words, understanding this racial and ethnic gap in health is a matter of life and death. Until studies routinely incorporate heterogeneity, nativity, and identity among Blacks, a clear understanding of the complexities that shape the Black health gap will remain elusive.

Second and relatedly, this research offers an answer to the continuing debate about whether collecting data on race and ethnicity is useful in understanding health disparities. Because both race and ethnicity were integral to the findings in this study, our approach is in line with the mandates of such leading organizations as the National Institutes of Health, which states that that research should include culturally appropriate data collection instruments that allow participants to self-identify with their racial and ethnic affiliation in a way that can explain health conditions and disparities (National Institutes of Health 2016). Efforts to halt or impede the recognition of race and ethnicity as important factors for understanding health disparities (see e.g., Epperson 2016) fall prey to the faulty assumption that health disparities will somehow disappear only when scientific and political entities ignore racial and ethnic variation in the population. The weight of the evidence on health disparities shows instead that disregarding race and ethnicity or engaging in colorblind logic actually leads to obscuring important information that can help improve the health and life chances of racial and ethnic minorities (Ver Ploeg and Perrin 2004; Williams et al. 2016; Ng et al. 2017). Intragroup differences such as the ones studied here (i.e., ethnicity and nativity) provide a more complete picture of the epidemiology and course of health problems (Williams et al. 2016; Ng et al. 2017).

Despite the strengths of this study, it is limited in a few respects. Identity and health are processes, including trajectories of change and stability over time. Without longitudinal data, we cannot fully map the connections between trajectories in racial group identity and health. Additionally, our examination of racial group identity does not assess the salience of identity. That is, other research indicates that the salience of an identity not only impacts the performance of roles in everyday life but also has implications for overall well-being (see e.g., Thoits 2012). While we adjust our analyses for gender, other research suggests that race-ethnicity and gender intersect in ways that make the processes shaping health very different for women compared to men (see e.g., Jackson and Williams 2006). Moreover, the extant literature also shows how the experience of immigration is related to health and other life chances varies greatly by gender (Lopez-Gonzalez et al. 2005; Gorman et al. 2010; Read and Reynolds 2012). Therefore, researchers in this area should continue to take on the task of understanding how gender combines with ethnic heterogeneity within racial groups and nativity to yield health outcomes.

Finally, our findings underscore that while the stress associated with racial discrimination is a risk factor for negative health outcomes that racial group identity can change this relationship. However, the manner and extent to which this modification happens are dependent on both ethnicity and nativity among Black Americans. In other words, neglecting to consider ethnic heterogeneity among this population may mask distinctive social positioning and experiences that affect how both identity and occurrences of discrimination are internalized and understood. Future research should continue to examine the complexity of the relationships among health, discrimination, and racial group identity. Such work remains important to the extent that developing a deeper understanding of how the impact of racial discrimination may be reduced by psychosocial resources will contribute to the understanding of inequalities in health more broadly.