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Am J Public Health. 2011 July; 101(7): 1314–1321.
PMCID: PMC3110243
NIHMSID: NIHMS258503

Race/Ethnicity, Socioeconomic Characteristics, Coethnic Social Ties, and Health: Evidence From the National Jewish Population Survey

Abstract

Objectives. We explored whether a White ethnic group with a history of structural disadvantage, Jewish Americans, shows evidence of continuing health impact independent of socioeconomic position (SEP), whether coethnic social ties appear health protective, and whether the strength of any protection varies by SEP.

Methods. In a series of ordered logistic regressions, we analyzed data from the National Jewish Population Survey, 2000–2001, regressing self-rated health on race/ethnicity, education, and income for US Blacks, Jews, and other Whites and, for Jews alone, indicators of coethnic social ties.

Results. controlling for SEP indicators, the self-rated health of Jews converged with that of Blacks and was significantly worse than that of other Whites. Access to coethnic social ties was associated with better self-rated health among Jews, with the strongest estimated association among those of lower SEP.

Conclusions. The finding that a White ethnic group with a favorable socioeconomic profile reported significantly worse health than did other Whites, after controlling for SEP, calls for better understanding of the complex interplay of cultural, psychosocial, and socioeconomic resources in shaping population health.

A longstanding literature supports the importance of social ties to health.1,2 Less is known about the importance of coethnic social ties to the health of racial/ethnic groups.3 Social ties can influence health as a buffer against the harmful effects of psychosocial stressors. Coethnic social ties may play a particularly beneficial role in mitigating the harmful effects of race/ethnicity-related stressors that contribute to excess disease prevalence among diverse groups, independent of socioeconomic position (SEP).426 Coethnic social ties may help members of marginalized groups develop or maintain a positive identity in the face of negative stereotypes.3,8,9,27 As James first speculated, strong ethnic social networks may protect the health of stigmatized racial/ethnic group members by providing identity safety and an affirming alternative cultural framework to the dominant, marginalizing one.3

Empirical evidence of this possibility is sparse, but suggestive. Dressler et al.28 found that the extent to which individuals in a southern rural African American community were able to live in accordance with culturally constructed local community norms—or enjoyed cultural consonance in lifestyle—was a stronger, independent predictor of hypertension and smoking than were conventional socioeconomic measures. A qualitative study by Viruell-Fuentes27 of women of Mexican origin in Detroit suggests the importance of coethnic social ties in countering the impact of the social psychological process of “othering.” For US residents of Mexican origin, othering occurs through encounters with non-Hispanic Whites. Infrequent othering encounters may contribute to the well-documented good health of recent immigrants,2937 whose everyday lives may not take them beyond the Spanish-speaking community. However, as immigrants with longer US residence and US-born children of immigrants have more frequent interactions with non-Hispanic Whites, they come face to face with US racial/ethnic dynamics. Through recognition of their stereotypic and subordinate place in the US racial hierarchy, othering encounters may threaten their health by, for example, activating physiological stress processes.10,38,39 Indeed, empirical evidence suggests that in middle age, US-born Mexican Americans and Mexican immigrants who are long-term US residents are at greater risk of suffering a high allostatic load—or stress-mediated wear and tear on important body systems—than are recent Mexican immigrants, despite having higher SEP and after controlling for measured differences in smoking, diet, physical activity, and medical care utilization.29

Further qualitative analysis of Viruell-Fuentes' Detroit interviews revealed that US-born participants highlighted the personal salience of constructing a positive identity and sense of belonging given the racialized, stigmatizing experiences they confronted in the broader social world.40 Social ties to Mexican friends and family played a critical role in the development of this shared positive Mexican identity. Members of other racial/ethnic groups who experience othering may experience similar benefits of coethnic social ties. The cultural affirmation they provide may be health protective.

James asked whether a marginalized racial/ethnic group's access to cultural affirmation may “become progressively more important to preserving the health of its members as the group's (economic) strengths … diminish.”3(p135) Pearson41 posited that cultural affirmation is always important to health whether or not it offsets material disadvantage and that this postulation stands true for all population groups. In Pearson's view, even the robust relationship between socioeconomic indicators and health seen in studies of non-Hispanic Whites may partly reflect their ability as the culturally dominant group to derive health benefits from enjoying a shared consensus on how their world functions and congruence in their ability to negotiate it on these terms.4144

Research exploring coethnic social ties or the dynamic cultural and economic resource dimensions of health focuses on low-income groups, populations of color, upwardly mobile groups, and immigrants. Findings cannot be interpreted without considering the unique experiences of immigration, social mobility, or being non-White in a race/ethnicity- and status-conscious society.2527,3032,45,46 Additional light may be shed on the health impact of coethnic social ties or of the interplay between cultural and economic resources by studying a population reflecting the minor divisions within the US White population. Such a population would be a White ethnic group that does not hold a full claim on dominant cultural resources, although able to access socioeconomic resources—a population that continues to experience ethnicity-related stigma.

The dominant US White culture is historically rooted in Anglo-Saxon Protestant culture.47 Over time, whether other groups who are generally viewed as White today—such as Irish Catholics, Italians, Slavs, and Jews—were to be counted as White was contested.46 Even currently, McIntosh48 describes White privilege as manifesting in part “as never having to consider one's skin color, geographic origin, or religious affiliation.” By this metric, ethnic groups remain who enjoy some but not all aspects of White privilege.49,50 Historically, US Jews suffered structural disadvantages in higher education and employment and blatant, institutionalized, and pervasive anti-Semitic sentiment.38 Jewish Americans have been described as becoming White only after WWII, with the advent of the GI Bill (Servicemen's Readjustment Act of 1944, P.L. 78-346, 58 Stat. 284m) and access to suburban housing,51 which broke down institutional barriers to social and residential mobility. Even so, Jews' specific history of institutionalized disadvantage has shaped their current ascribed social location. They have been described as being among the US ethnic groups that experience “Whiteness of a different color.”49 They continue to face negative stereotyping and othering encounters.5256

Considering the Jewish American population in light of the perspectives and research findings reviewed suggests that if Jewish Americans as Whites have frequent interactions with mainstream American social institutions in their daily encounters, they may as “outsiders” experience othering and exposure to stigmatizing messages. These experiences could adversely affect their health, independent of SEP. Coethnic social ties that provide cultural affirmation, a sense of belonging, and identity safety may mitigate this impact. Following James's speculation of a dynamic interplay between cultural and economic resources, coethnic social ties may especially protect low-SEP Jewish Americans. Conditional on conventional SEP indicators, we hypothesized that (1) Jewish Americans are less healthy than are other US Whites and more healthy than are US Blacks, (2) Jewish Americans with greater access to social ties that affirm their alternative sociocultural identities (whether religious or secular) have better health than do those with less access, and (3) Jewish Americans of lower SEP realize greater benefits to their health from such social ties than do those of higher SEP. The National Jewish Population Survey (NJPS), 2000–2001, the most recent and broadest survey of the US adult Jewish population, offers us a unique opportunity to begin to test these propositions.

METHODS

We analyzed data from the NJPS and the National Survey on Religion and Ethnicity (NSRE), 2000–2001, both of which are described at length elsewhere.5760 In brief, a random digit dialing procedure was employed to screen US households for possible inclusion, using a stratified sample. All screened households were weighted to represent household distribution and to adjust for disproportionate sampling rates among strata using 2000 census data.

Screening questions were asked about all adults in the households contacted. On the basis of these questions, each household adult was categorized as Jewish, a person of Jewish background, or non-Jewish. Jewish households were administered the NJPS. A random subsample of people of Jewish background households had a short-form NJPS interview. A subsample of non-Jewish households was randomly selected for the NSRE interview, which was shorter. If households had 1 qualified Jewish or person of Jewish background adult, that person was selected to participate. In households where 2 or more adults qualified for participation in either the NJPS or the NSRE, 1 was randomly selected to be interviewed.

A total of 9175 adults completed the NJPS or NSRE questionnaires. Weighted data from this combined sample are representative of the total US household population. After excluding respondents who self-identified as other than White, Black, or Jewish, we analyzed data for the remaining 8566 respondents: 5148 Jews or people of Jewish backgrounds, 2881 Whites (non-Jewish), and 537 Blacks.

Self-rated health was the only health outcome asked of all respondents to the NJPS and NSRE surveys. No objective measures of health were collected. Widely used, self-rated health has been found to be a reliable and valid measure of objective health status across diverse US populations.6063 Self-rated health is an ordered categorical variable, coded in ascending order as 1 = poor, 2 = fair, 3 = good, and 4 = excellent.

Control variables used in all models were age, gender, and census region of residence: Northeast, Midwest, South, and West. Controlling for region considers the skewed distribution of Jews and Blacks across the 4 regions (see Table 1) and adjusts for cost-of-living differences across regions in models controlling for income.64

TABLE 1
Frequency Distribution of Study Variables by Racial and Ethnic Categories: National Jewish Population Survey and National Survey on Religion and Ethnicity, United States, 2000–2001

SEP indicators were (1) education, an ordered categorical variable coded in ascending order with survey response categories of less than high school, high school, some college, college graduate, or graduate or professional school; and (2) total household pretax income from the previous tax year, an ordered categorical variable coded in ascending order: less than $25 000, $25 000 to $49 999, $50 000 to $99 999, $100 000 and greater, and missing. The missing group did not differ significantly on education or self-rated health from those in the same racial/ethnic category who reported income.

Indicators of access to Jewish social ties were extent personally religious, denomination, and proportion friends Jewish. Religious observance may be one way that Jewish Americans forge coethnic social ties or derive the benefit of being a member of a culturally affirming group. Proportion friends Jewish is a measure of coethnic social ties, applicable regardless of whether one is religious or affiliated. Extent personally religious is an ordered categorical variable coded in ascending order as not at all, not very, somewhat, and very religious. We coded denomination as none, Jewish background only, Reconstruction or other Postdenominational, Reform, Conservative, and Orthodox. Proportion friends Jewish was measured using a Likert scale question in which respondents answered whether none, some, about half, most, or all their friends were Jewish.

To test our first hypothesis that conditional on SEP the health of Jewish Americans will be intermediate between US Blacks and other Whites, we regressed self-rated health on race/ethnicity and the control variables and then included measures of education and income, individually and then combined in a series of ordered logistic regressions. To test our second hypothesis, we analyzed data for the Jewish respondents and focused on the indicators of Jewish social ties—extent personally religious or proportion friends Jewish—adding these variables to the regressions. To control for potential confounding of religiosity and Jewish social ties given the greater likelihood that Jewish respondents who participate in an organized, observant religious community have Jewish friends, we also included controls for extent personally religious and denomination when we regressed self-rated health on proportion friends Jewish.

To test our third hypothesis, we replicated these analyses, stratifying by education. As a robustness check, we also performed analyses of the Jewish sample, controlling for generational status. Results were insensitive to the inclusion of this variable, and we dropped it from the analysis. Study findings were also robust to the exclusion of older respondents (those aged 60 years and older). All regressions were estimated using sample weights, and confidence intervals (CIs) were calculated using Huber–White standard errors.65

RESULTS

Table 1 displays frequencies of all variables for the total sample and, where applicable, by each racial or ethnic group. Whites and Jews reported excellent health in roughly equal percentages, while only about three quarters of that percentage of Blacks reported excellent health. Blacks reported the largest proportion of being in fair or poor health. Jewish Americans, on average, had completed a higher level of schooling and had a higher income distribution than did other Whites and Blacks, suggesting that they were able to access US socioeconomic resources. Almost one quarter of the Jewish respondents reported having no denominational affiliation. About 37.0% reported being not at all or not very religious and almost half reported being somewhat religious, whereas 16.7% reported being very religious. Roughly equal percentages reported having only some or no Jewish friends or having most or all Jewish friends. The remaining fifth reported that about half of their friends were Jewish.

We present all logistic regression results as proportional odds. Table 2 presents information regarding the simple relationship between self-rated health and each of age (controlling for gender), education, and income (controlling for age and gender), overall and by racial/ethnic group. As a general statement, each of these characteristics was associated with self-rated health in the expected way. Respondents in the older age categories (aged 60 through 69 years and 70 years or older) were less likely to report positive self-rated health than were those in the referent age category (aged 40 through 49 years). Respondents with a higher level of education had better self-rated health compared with those with less education, as did those with higher annual incomes, except for Blacks in the highest income group. This odds ratio (OR) was imprecisely estimated, owing to the small number of Black respondents (N = 21) with an annual income of $100 000 or greater.

TABLE 2
Ordered Logistic Regression of Association of Demographic and Socioeconomic Characteristics to Self-Rated Health by Racial/Ethnic Category: National Jewish Population Survey and National Survey on Religion and Ethnicity, United States, 2000–2001 ...

To address hypothesis 1, Table 3 provides estimated ORs of self-rated health for Jews and Blacks relative to Whites before and after adjusting for education and income. Estimates controlling only for age, gender, and region showed that Blacks were 0.55 times (P ≤ .001) less likely than were Whites to report more favorable self-rated health. The distribution of self-rated health for Jews and Whites was equivalent.

TABLE 3
Relationship of Race/Ethnicity to Self-Rated Health, Before and After Adjusting for Socioeconomic Characteristics: National Jewish Population Survey and National Survey on Religion and Ethnicity, United States, 2000–2001

When estimated ORs were adjusted for education, Blacks were 0.62 times (P ≤ .001) less likely than were Whites to report more favorable self-rated health. However, Jews joined Blacks in being statistically significantly less likely than were Whites to report more favorable self-rated health, with the estimated OR (Jews vs other Whites) falling from 0.96 to 0.72 (P ≤ .001) with the introduction of a control for education. Estimates showed that when differences in income distribution were accounted for, Blacks and Jews were significantly less likely to report favorable self-rated health relative to Whites. When both education and income were accounted for, Jews were even less likely to report favorable self-rated health, and the OR relative to other Whites of 0.68 (P ≤ .001; 95% CI = 0.59, 0.79) converged with the OR for Blacks of 0.71 (P ≤ .001; 95% CI = 0.55, 0.91).

Addressing hypothesis 2, in Table 4 we report estimated ORs of self-rated health for Jews only, focusing on self-reports of the extent of personal religiosity and the proportion of friends who are Jewish. Adjusting for age, gender, and region only, we saw no relationship between the extent of personal religiosity and self-rated health. Once the socioeconomic characteristics were also controlled, the point estimate comparing Jews who were very religious to those who were somewhat religious increased and became marginally significant (P < .10).

TABLE 4
Estimates of the Relationship Between Indicators of Coethnic Social Ties and Self-Rated Health Among Jewish Americans, Before and After Adjusting for Socioeconomic Characteristics: National Jewish Population Survey, United States, 2000–2001

Table 4 shows the association between the more direct indicator of coethnic social ties, proportion of friends who are Jewish, and self-rated health. We found that having few Jewish friends was associated with worse self-rated health, whereas having many Jewish friends was associated with better self-rated health. These findings are generally robust when controlling for indicators of SEP and religiosity. The most consistent finding was that having many Jewish friends compared with having about half was associated with better self-rated health, after controlling for SEP and religiosity, with even larger gaps between respondents with many and those with few Jewish friends.

In Table 5, we report findings for interactions intended to shed light on hypothesis 3: that Jewish Americans of lower SEP will realize greater benefits to their health from access to coethnic social ties than will those of higher SEP. We report findings for high school education or less versus greater than high school education, the socioeconomic indicator with little missing data.

TABLE 5
Interactions of Indicators of Coethnic Social Ties and Socioeconomic Position on Self-Rated Health Among Jewish Americans: National Jewish Population Survey, United States, 2000–2001

Table 5 shows that when stratified according to educational level, those with greater than a high school education showed little evidence that the extent to which they were personally religious affected their self-rated health. However, among those with no more than a high school education, there was a sizeable and significant association between being very personally religious and having higher self-rated health. Having a greater proportion (more than half) of Jewish friends was significantly associated with having higher self-rated health for both education groups. However, the estimated magnitude was greater among those in the lower education group compared with those with a higher education.

DISCUSSION

Study findings are consistent with the hypotheses and provide some evidence that having coethnic (in this case, Jewish) social ties may be health protective for members of racial/ethnic groups who are located in negatively stereotyped positions in the dominant cultural racial/ethnic hierarchy,3,27 even if they are racially classified as White.41 Regarding hypothesis 1—that after controlling for conventional indicators of SEP, Jewish Americans are less healthy than are other US Whites and more healthy than are US Blacks—we found that at the same levels of education or income, Jewish Americans reported worse health than did other Whites and more closely approximated Blacks. The initial parity between Jews and other Whites when only age, gender, and region were controlled was a result of Jews having more favorable education and income distributions than other Whites, overall, and these socioeconomic characteristics being positively associated with self-rated health for Jews and for other Whites.

The finding that other Whites had substantially more favorable self-rated health after considering education and income than either Jews or Blacks also implies that their overall health advantage is the result of unmeasured factors in addition to the measured socioeconomic characteristics. This finding is consistent with Pearson's perspective, that focusing exclusively or uncritically on conventional SEP indicators may overestimate the contribution to health of material resources per se and that having a full claim on unmeasured dominant cultural resources may also contribute.41 Alternatively, unmeasured wealth differences may account for the more favorable self-rated health reported by other Whites, after controlling for education and income.66,67 Data limitations precluded including a wealth variable. However, we note that estimates for Jews in the NJPS suggest a median net worth of approximately $250 000, which is substantially higher than the median net worth reported for Whites ($121 000) or Blacks ($17 000) in the Federal Reserve Board's 2001 Survey of Consumer Finances.68 Thus, unmeasured wealth is unlikely to account for these findings. If anything, these figures suggest that the self-rated health disparity between Jews and other Whites may be underestimated.

Our findings are consistent with hypotheses 2 and 3 but are most judiciously viewed as suggestive. We were highly constrained in our choice of variables to measure coethnic social ties or proxy cultural affirmation, and we were without information on the nature or quality of these ties. Regarding hypothesis 2—that Jewish Americans with greater access to affirmation of their alternative sociocultural identities have better health than do those with less access—a (marginally) significant relationship between being very religious and having higher self-rated health surfaced only after controlling for income and education. When we turned to the proportion of friends who are Jewish, a more direct indicator of coethnic social ties that is applicable to religious or secular Jews, we found that those with greater compared with lesser proportions of Jewish friends reported higher levels of health overall after controlling for socioeconomic characteristics and religiosity.

We also found evidence of interaction effects, suggesting that the overall findings mask realities that are more complex. After controlling for the main effects of income and education, being very personally religious was associated with having higher self-rated health only among Jews of lower SEP. After controlling for the main effects of income, education, and religiosity, having more than half of one's friends being Jewish was strongly associated with having higher self-rated health among Jews of both education groups, but the estimated size of the association was larger for those with a lower educational level than it was for those whose educational achievement was higher. These findings are consistent with the speculation by James that a racial/ethnic group's cultural strengths “become progressively more important to preserving the health of its members as the group's (economic) strengths … diminish.”3(p135)

We note several study limitations. This investigation used cross-sectional data, impeding our ability to evaluate competing explanations for the associations we report. Objective health measures to corroborate reports of self-rated health would have strengthened the study. As we had no direct measures of the qualitative nature of the friendships, whether the higher self-rated health associated with having a larger proportion of friends Jewish was owing to the cultural affirmation or identity safety that being with coethnic friends may provide is one interpretation. Data limitations precluded us from considering other ethnic groups who, like Jews, may not enjoy the full privileges of Whiteness and may suffer ethnicity-related stressors or stigma, even as they may have favorable socioeconomic profiles. Other White ethnic groups of European descent, as well as groups such as Muslim, Arab, or Asian Americans, may suffer less pervasive or entrenched discrimination than do Blacks and have higher levels of education or income on average but may nevertheless fail to enjoy all the cultural or psychological rewards of White privilege with consequences for their health.12,69

Most studies of racial and ethnic health disparities in the United States focus on differences across racial groups, giving little consideration to ethnic variation within these groups. Those few studies that have considered ethnic variation focus almost exclusively on populations of color and variation in nativity status.26,70 It is often assumed that ethnic groups who have “become White” or have achieved high levels of SEP no longer suffer race/ethnicity-related disadvantage. Yet, it may be wise to consider that access to educational, economic, or neighborhood resources—critically important as they are—do not necessarily equate to full access to dominant cultural rewards and privileges or freedom from the sting of negative stereotypes.

Study findings support the need for more detailed investigations that focus on how navigating the US racial/ethnic structure or coping with associated stressors and othering experiences may harm health, as well as on how coethnic social ties or access to other affirming cultural resources may interact with socioeconomic characteristics to influence health and perceptions of wellness across and within a broader range of populations, including Whites.3,8,9,27,28,41 The fact that a population group currently classified as White that has, on average, surpassed other Whites in income and educational attainment appears to have significantly worse health than do other Whites after controlling for these socioeconomic characteristics calls for better understanding of the impact of dynamic social psychological stressors on health, not only for this group but also for all racial/ethnic population groups.

Acknowledgments

The authors gratefully acknowledge financial support for this research from the National Institute on Aging (grant 5 T32 AG000221), the Eunice Kennedy Shriver National Institute for Child Health and Human Development (ARRA supplement to grant R21 HD056307), and the Center for Advanced Study in the Behavioral Sciences at Stanford through a fellowship to A. T. Geronimus.

We are also indebted to John Bound, Gilbert C. Gee, Harold W. Neighbors, and James S. Jackson for comments on earlier versions of the article and to Diane Laviolette for help with preparation of the article.

Human Participant Protection

Because all data were obtained from secondary sources without personal identifiers, the institutional review board at the University of Michigan approved this study as exempt from full review.

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