The Intersectionality Between Bi and Multiracial College Students’ Self-identification and Their Behaviors—A Pilot Study
PMCID: PMC12966193
PMID: 39907896
Abstract
Due to limited information and published research, health disparities among bi and multiracial (B/MR) groups are not as understood as other racial groups. Without this knowledge and ability to allocate resources as needed, this is another racial group that could suffer from poorer health outcomes. As a result, participants ( n = 15) were placed in focus groups or individual interviews with ten qualitative questions. Each participant then completed an anonymous quantitative survey assessing their health-related behaviors. Quantitative results included 40% ( n = 6) of participants who tried cigarettes, 53% ( n = 8) who tried electronic vapor products, and only 20% ( n = 3) of participants who got the recommended hours of sleep nightly. Qualitative results include themes of situational identity, White assimilation, and pressure to explain their identity. Many participants dealt with the insensitivity that one side of their family exhibited towards the other side of their identity through inappropriate jokes and comments. Lastly, there were expectations from both family and friends to act a certain way. Researchers identified three major categories that the participant’s influences fell into. Genetics, Culture/Heritage, and the Environment are the aforementioned categories that can work together or stand alone to influence behaviors that can ultimately affect health outcomes. While these results are based on a small sample size ( n = 15) of undergraduate B/MR students, it does suggest that researchers should complete a more extensive survey on this racial group to verify these findings.
Full Text
The Center for Disease Control’s National Center for Health Statistics (NCHS) collects, assesses, and publishes data along with the resulting health outcomes for numerous racial groups, including but not limited to Asian Americans, Black Americans, Caucasians, and Hispanic/Latino Americans (see NCHS → Topics → Life Stages and Populations → Race/Ethnicity) [1]. While this is an excellent resource, one racial group is noticeably absent from this list—multi- or biracial individuals. This is especially troublesome since this population will double in size by 2050 [2]. The implications for this racial group doubling in size while not understanding their health needs are quite significant. Without this knowledge and ability to allocate resources as needed, this racial group could suffer poorer health outcomes.
The relationship between race/ethnicity and health outcomes is a topic of ongoing and pertinent discussion within the public health field. Numerous researchers have evaluated health behaviors and links between health outcomes/status and racial identification. The Kaiser Family Foundation (KFF) clearly illustrated that health disparities exist and impact specific communities. For example, Black Americans and Hispanic Americans have higher mortality rates, and are less likely to have access and coverage and receive quality health care [3]. For example, although the Black-White cancer disparity has decreased, Black Americans share a disproportionate burden in deaths for both males and females [4]. According to the CDC, African Americans are not the racial group most likely to use tobacco [5]. However, this group disproportionately suffers more from chronic health outcomes related to this issue, such as heart disease, cancer, and respiratory issues. Alcohol use is another behavior that many individuals perform, regardless of their racial and ethnic groups. According to the NSDUH (National Survey on Drug Use and Health), lifetime alcohol use among all racial groups in 2018 was 83.7% of AI/AN, 70.6% of Asians, 80.2% of Blacks, 78.3% of NHOPI, 91.6% of two or more races, and 92.0% of Whites [6]. However, African Americans are more likely than most groups to experience poorer health outcomes concerning alcohol consumption.
It is important to note how the history of racism in the USA has affected racial identification, especially for those mixed with Black and White races. Before 1950, the way a bi or multiracial (B/MR) individual identified was not their choice; it was an external decision. The “one-drop” rule, which indicated that a person with any amount of Black blood must identify as Black, was used to reinforce social hierarchy and class systems [7]. However, this rule was so deeply ingrained into the Black community that even when people of mixed race were given the option to identify as B/MR many did not.
It has only been 53 years since the landmark Supreme Court decision of Loving vs. Virginia, which declared interracial marriages as being constitutional in the USA [8]. It was difficult for the USA to acknowledge interracial marriages, let alone their byproducts, being Biracial/Multiracial children. The Multiracial Movement of the 1990s called for a fundamental change to how the federal statistical system classified people by race, calling for the option to choose more than one race in the national census [9]. Due to pressure from the movement, Census 2000 and subsequent federal statistical documents allow for individuals to identify with as many of the listed racial categories as they wish. Because of the knowledge gained from the now available census data, we are able to monitor and predict the rapid growth of this racial group. Kaiser Family Foundation (KFF) acknowledges that the population of those who self-identify as B/MR will double in size by 2050 [3].
Additionally, data collected by national surveys did not account for multiracial individuals when these surveys first started gathering information. This means that those who were self-identifying as biracial or multiracial had to choose an identity for categorization that did not match their intrinsic beliefs. The Behavioral Risk Factor Surveillance System (BRFSS) began in 1984 and added an “other” category in 1985. Only in the 2001 survey did individuals have the choice to choose “one or more of the following…” [10]. Its counterpart, the Youth Risk Behavioral Surveillance System (YRBSS), started in 1991 with an “other” category but only started with their 1999 survey allowing individuals to “select one or more responses” for their race question [11]. Based on these surveys, it seems B/MR individuals, specifically adolescents, were the “forgotten” population. Though there have been efforts to correct this, this population often continues to receive little acknowledgement as its own subset of the B/MR population.
The identity of multiracial individuals is fluid and affected by internal and external factors. For college students, identity development continues through both public and private spaces. Public spaces include residence halls, student organizations, classrooms, and social events. Private spaces include journaling, academic projects, or conversations with trusted others [12]. Social constructs affecting identity and identity development include gender, social class, family, community, peers, age, spirituality, social awareness, cultural awareness, and geographical region [13]. A quote from Grillo states, “When an adolescent begins to question who they are, this process often begins with who they are in comparison to other people” [7p431].
Although ethnic identity is a cultural component and not a biological one, like racial identity, this sets an important framework for B/MR individuals who blend both biological and cultural components in order to discover their sense of self. Jean Phinney, a psychologist who has a great deal of work focusing on social psychology and ethnic groups and ethnic identity development, as well as identity and developmental psychology, has developed a 3-stage model that is commonly accepted for ethnic identity development [14]. Phinney defines ethnic identity in three stages: “(a) commitment and attachment—the extent of an individual’s sense of belonging to his or her group; (b) exploration—engaging in activities that increase knowledge and experiences of one’s ethnicity; (c) achieved ethnic identity—having a clear sense of group membership and what one’s ethnicity means to the individual [14p3, [15].” For individuals who identify as B/MR, ethnic identity development is further explained by Poston’s Biracial Identity Development Model, which includes a progression through the following stages: (a) Personal Identity; (b) Choice of Group Categorization; (c) Enmeshment and Denial; (d) Appreciation of Multiple Identity and Exploration of Heritages; (e) Integration and Valuing of Multicultural Identity [16]. Furthermore, multiracial individuals tend to feel between two (or more) identities instead of feeling accepted in all parts of their identity. This can lead to feelings of not belonging, creating stress that can affect one’s health. These feelings of being stuck between two identities tie into both the marginal man theory and double consciousness as coined by WEB Du Bois [7, 17].
There are a variety of societal issues that are unique to this population, especially on college campuses. An article written by a multiracial woman named Allison King highlights her experiences in college dealing with identity and the experiences of other biracial or multiracial college students she included in her study [12]. Her study’s results included major themes around issues with a sense of belonging, having the inability to exist and figure out their identity as they grew. Feelings of alienation or loneliness, trying to balance identifying with both or all parts of their identity, peer pressure to choose one social group over another or being forced into one group based on appearance, discomfort in their identity, or feeling invisible were also themes present in her research.
The B/MR community is also forced to face the unique issue of monoracism, which is a variant form of racism that prioritizes privileging monoracial identities. This concept contributes to the erasure of multiracial people’s experiences. On an institutional level, monoracism has shaped preferences towards the conceptualization of race to be viewed in mutually exclusive terms and categories [18]. Monoracism presents its effects in many forms, including monoracial student recruitment and retention centers on college campuses, electronic medical databases and record systems that are programmed with the inability to handle more than one race selection at a time, multiracial people needing to defend their self-identifications, healthcare professionals making inappropriate assumptions or comments based on physical appearance, or TSA workers flagging parents of multiracial children for potential trafficking because their children may not look like them, or even simply not having an opportunity to choose more than one race when filling out documentation [18].
Another set of issues revolves around lacking the cultural tools to be accepted into a certain group; tools including language, experiences, or cultural knowledge [12]. The participants also experienced social exclusion from peers from one or another racial group that the student identifies with. In addition, multiracial students struggle from a lack of individual or organizational representation on their campuses. These students lack safe spaces on their campuses where they are not forced to conform to just one part of their identity. Recommendations for improving acceptance in the college setting for multicultural students from King include having open conversations about multicultural identity, creating organizations for multicultural students, and better representation of multiracial students on campus (including faculty and staff) [12].
Previous studies implicate further health research on the B/MR population. Structural and conceptual frameworks suggest various factors that affect one’s identity and, as a result, their behaviors and health outcomes. Both race and socioeconomic class jointly contribute to health risks. For B/MR individuals, stress has been identified as a critical mediator in their health outcomes as it is related to their identification. This is especially true when one’s identity is misaligned with the outside perception of their identity, which is a common issue within this population [7]. Often, when one’s self-identification does not match their physical appearance, it can lead to feelings of disconnectedness and lower levels of psychological well-being [7]. Furthermore, researchers analyzing data from the Adverse Childhood Experience Questionnaire discovered multiracial individuals having higher reported rates of anxiety than their monoracial peers [19].
For multiracial individuals, imposter syndrome can affect identity. Jennifer Cheang, a Chinese and Puerto Rican author, states, “I’ve always been considered “half” or “watered down” versions of my Chinese and Puerto Rican identities [20].” This sense of not belonging makes one feel like an imposter in their own identity. Issues she notes are faced in the multiracial community include colorism, exclusion, isolation, lack of representation, privilege, and finding healing [20]. Though many health findings indicate that biracial individuals experienced poor mental and physical health outcomes. Other findings indicate that B/MR individuals who have a positive relationship with their identity are linked to good psychological health including higher self-esteem, increased efficacy, and decreased stereotype vulnerability [13].
Researchers analyzed data about young adult college students collected by the Healthy Minds Study in one study. Their findings indicate that multiracial college students, compared to their monoracial peers, experienced higher rates of mental and behavioral health issues, including depression, anxiety, languishing, perceived need for help, loneliness, and drug use (p < 0.001). This group also presented an increased likelihood of having psychiatric disorders as compared to their monoracial peers. Psychiatric disorders, including depressive disorders, bipolar disorders, trauma (stressors) disorders, neurodevelopment disorders, eating disorders, and personality disorders, were all more prevalent within the multiracial student sample than for their monoracial peers (p < 0.029 or less). Findings within this study presented modestly greater odds of all mental and behavioral health outcomes to occur for multiracial individuals [21]. This adds significant information to the conversation surrounding B/MR college students and health behaviors, as these issues are significantly impacted by environment, identity, and societal acceptance. As we learn more about this racial group, we hope to uncover the intersectionality of self-identification and health behaviors within this population.
In a study comparing the health risk status of mixed-race adolescents between the 7th and 12th grades with their single-race counterparts, mixed-race individuals were found to have a higher prevalence in areas such as poorer general health, waking up tired, skin problems, headaches, aches and pains, sleep problems, depression, regular smoking, regular drinking, and being regularly drunk [22]. Additionally, mixed-race adolescents were also within the boundary values for the non-risk individual and family attributes of the single-race groups that constitute their identities, such as student GPA, family structure, and family education [22]. Meaning, these student scores were found to lie between the norms of their family’s monoracial identification. Furthermore, this corresponds with research indicating that for studied health-related behaviors (smoking, sexual health, and alcohol use), B/MR individuals fall between the norms of their monoracial peers, when performing these behaviors [23].
For multiracial adolescents, situational identities are often formed where the individual will shift between categorizations, using whichever serves them the best at that time. This is an example of code-switching. The American Psychological Association defines code-switching as “the practice typical of individuals proficient in two or more registers [24].” With the fluidity of multiracial identity, we find that B/MR individuals may choose to self-identify differently in different settings or times in their lives [18]. Though establishing situational identity can be helpful in the short term, studies have shown that higher self-esteem and higher socioeconomic status are associated with lower rates of moving between racial categories [13].
We have established notable health and social implications for the B/MR community influenced by their race. Social implications include feelings of not belonging, stress, alienation, loneliness, invisibility, disconnectedness, imposter syndrome, and lowered psychosocial well-being. Health risks such as poorer general health, waking up tired, skin problems, headaches, aches and pains, sleep problems, depression, regular smoking, regular drinking, and being regularly drunk have been studied in Udry’s research [22]. Conversely, there is research to support positive relationships between multiracial heritage and health when there is a positive relationship with one’s identity. This is supported by Renn, who linked a positive relationship with multiracial identity to higher self-esteem, increased efficacy, and decreased stereotype vulnerability [13]. The lack of mass empirical research on self-identified multiracial individuals, specifically multiracial college students, has led a research group at a small Midwest liberal arts college in Ohio to explore this population. B/MR individuals are an increasing demographic, which calls for increased literature and research that can be used to help identify the needs of this population, especially within the public health space. In the following study, researchers seek to explore the attitudes, beliefs, and factors that affect their health. We aim to answer the question, “What is the intersectionality between undergraduate college students who self-identify as Bi or Multiracial (B/MR) and their behaviors?”.
Due to scheduling conflicts, the principle investigator and three research assistants ran four focus groups and three individual interviews independent of the focus groups. Each focus group included 2–5 students structured with ten questions asked in each session by the principle investigator. The principle investigator conducted all sessions, which were also recorded for clarity using OtterAI [25]. The research assistants took notes for thematic responses throughout the interview and focus group sessions. After participation in the focus groups, each participant was asked and completed an anonymous survey with 48 questions to assess their health-related behaviors. This was done in order to gain more intimate and sensitive data about each participant’s behavior.
While 10 questions were asked during the focus groups/interview sessions, 6 of those questions were assessed in this paper (see Table 1). A total of 48 questions were included in the survey, of these 38 questions came from the YRBSS (Youth Risk Behavioral Surveillance System). Lastly, four questions from the CDC Health-Related Quality of Life (HRQOL) assessment were included [26]. Overall, questions included in the survey covered behaviors such as smoking/vaping, sexual, alcohol use, nutritional habits, sleep behaviors, and demographics. Most questions were nominal or ordinal, closed-ended, and “forced” the participant to select an answer.
For the quantitative data, the information was coded, cleaned, and inputted into SPSS (Statistics for the Social Sciences), version 26 [27]. Descriptive analysis was completed to assess means, percentages, and counts for the 15 surveys that were completed.
For the qualitative data, OtterAI software was used to download and convert the content of the interviews and focus groups to Microsoft Word [25]. The findings were then reviewed by researchers and cleaned up to ensure the typed version matched the audio recordings. Thematic analysis was conducted among the research team and recurring themes were pulled from the interview and focus group results. This process was completed by three members of the research team individually and themes were discussed in a group setting to identify the most significant recurring discussion points.
For the quantitative survey, participants answered questions about their health behaviors. Health behaviors analyzed include alcohol consumption, sexual health, healthy days, sleep, vaping, smoking cigarettes, fruit and vegetable consumption, and whether or not they have seen a dentist in the past 12 months. Table 2 shows many of the behaviors assessed in this survey by frequency and percentage. Other behaviors, such as alcohol, sexual health, and healthy days, are summarized in the following sections.
Participants were asked about their healthy days over a 30-day period using the Health-Related Quality of Life (HRQOL) questionnaire [26]. The first question assessed the general health of the participants, with the options being “excellent,” “very good,” “good,” “fair,” or “poor.” Of all participants (n = 15), 6.7% answered “excellent,” 13.3% answered “very good,” 46.7% answered “good,” 33.3% answered “fair,” and there were no responses for “poor.” The second question assessed physical health, including physical illness and injury, and how many days during the last 30 days the participants had poor physical health. The mean answer (m = 5.2 days) indicates that the participants had poor physical health on average, just under 1 week for the past month. The third question states, “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” The mean answer (m = 15.7 days) indicates the participants’ suffered from poor mental health over 2 weeks for the past month. The final question about healthy days states, “During the past 30 days, approximately about how many days did poor physical or mental health keep you from doing your usual activities such as self-care, work, or recreation?” The mean answer (m = 8.1 days) indicates that the participants were unable to perform their normal functions for just over a week within the past month due to poor health.
Throughout the analysis of these results, researchers discovered three major themes that have the capacity to stand alone or work together to help explain the behaviors of members within the B/MR community. The influences of genetics, culture/heritage, and the environment are all contributing factors in determining the behaviors which can affect health outcomes. Figure 1 demonstrates this conceptual framework as a Venn diagram with three overlapping circles each containing distinct constructs that can be used to predict the influences on behaviors of an individual, especially as it relates to health within this population. Furthermore, these three concepts fit nicely within Bronfenbrenner’s Ecological Systems Theory [28]. To further explain, the genetics, culture/heritage, and environment constructs revealed in this research fit within Bronfenbrenner’s microsystem level. In contrast, the interaction among these three constructs, which can lead to a particular behavior, falls within the mesosystem.
As indicated by Renn and Smith, “Bronfenbrenner’s (1977, 1995) bioecological systems model is one of the most widely used in studies of human development” (p. 13) [29]. The model proposes four features of an ecological system that characterize the setting in which human development occurs. These features are as follows: Person, Process, Context, and Time (PPCT). Person refers to the developing individual and their unique characteristics. Context includes four nested ecological systems (the microsystem, mesosystem, exosystem, and macrosystem). Process involves interactions between the person and their ecological systems. Time represents lived experiences, historical events, and societal changes that span a person’s lifetime.
Additional findings from this study reveal the impact of environment on college students’ health-related behaviors and outcomes. Renn’s model of Biracial and Multicultural identity expands Bronfenbrenner’s ecological theory and identifies five patterns of identity among multicultural college students, several of which are represented in the current study: (1) Student holds a monoracial identity; (2) Student holds multiple monoracial identities, shifting according to the situation; (3) Student holds a Multiracial identity; (4) Student holds an extraracial identity by deconstructing race or opting out of identification with US racial categories; and (5) Student holds a situational identity, identifying differently in different contexts [30, 31]. Evidence of these patterns of identity has been noted through the current analysis, thus further validating Renn’s findings [30, 31].
There are numerous ways that genetics impacts identity, behavior, and health. Throughout the discussions, the participants mentioned specific genetic issues, such as familial histories of mental health and chronic conditions or illnesses. These were discussions that were not planned for but contributed to a significant theme nonetheless. All of the aforementioned examples did influence the participant’s behavior; however, the one genetic issue and theme that seemed to resonate the most pertained to the way a person looks. A recurring theme within the responses includes the idea of being White passing and the privileges that come with that, due to the fairness of their complexion. White passing is when someone perceives a BIPOC person (Black, Indigenous, and People of Color) as a White person, for whatever reason [32]. The privileges that accompany this trait include safety and opportunity in areas like travel, education, and employment [33]. However, there are also some disadvantages identified by participants that come with White passing. One of which is the idea that lacking features commonly associated with a cultural or racial group leads to imposter syndrome when making cultural choices. This can lead to a B/MR individual feeling the need to explain oneself for choices that they are entitled to make. These appearances lead to feelings of either validation or invalidation, and how the participants feel about themselves racially, or within their skin.
This is important because B/MR children often have different cultural experiences than their family members. Oftentimes, members of this community are celebrated for muted culture on one side of their family and ridiculed for it on the other. Whether it is their lack of knowledge about the history, language, heritage, and culture on either side of their racial identity, or attempting to assimilate towards one side or the other, participants recall frequent ridicule and labels of being “washed out,” “watered down,” or incomplete versions of either side of their identity. Cheang, who is Chinese and Puerto Rican, stated, “I’ve always been considered “half” or “watered down” versions of my Chinese and Puerto Rican identities [20p2].” This sense of not belonging makes one feel like an imposter in their own identity. Her findings found that this led to issues that the B/MR community face, which includes colorism, exclusion/isolation, lack of representation, privilege, and finding healing [20]. Furthermore, the participants did not mention having the opportunity to learn more about the other side of their identity, nor did their families go out of their way to educate them. This leaves these participants feeling less culturally competent or belonging than their monoracial peers from either side of their identity. One participant was quoted stating, “I felt like our home experiences [were] pretty monoracial because the only real culture that’s existing here is brown culture.” Explaining that the White part of their racial identity does not necessarily have a culture nor was that culture discussed at home. Rather, they fed off American culture. Unfortunately, this can and frequently did lead to reported situations of gaslighting and hostile environments from one side of their family as it related to the other side of their racial identity from the participants within the study.
Bi and multiracial individuals, no matter their genetic makeup, identify as having a common culture more similar to one another’s experiences than either/any of their monoracial sides of their identity. This was an overarching theme throughout this study, and one that other studies identified as well [33, 34]. A participant stated, “…a lot of my friends, like my really close friends and I still have and have had for a long time are also multiracial, and that I have more in common with people, even if they’re a completely different mix than I am, who are mixed, than I do with either my like identities…”.
Environmental influences, both internal and external, also represent a major set of themes in this study which can influence identity, behavior, and health. A major environmental influence includes assimilation towards Whiteness while attempting to mask their minority culture. This could occur conscious or subconsciously, and by design, either internally or due to outside factors. This was reported due to career pressure to “act whiter” in order to make friends, build relationships professionally, or climb the corporate ladder. An example often portrayed is through their hair which was a common theme among participants [35]. This issue, unfortunately, is something introduced to children of color far before they enter the workplace. Over a decade of national research indicates that girls of color are most likely to be disciplined in school for the ways they wear their hair, whether that be through hair as self-expression, culturally rooted hairstyles, or hair coverings. The option to choose how to wear their hair is a natural and important part of healthy adolescent development in young girls of color [36].
Participants also reported feelings of pressure to explain their identity to others, especially when their outer appearance does not match their personal identification. Their looks lead to feelings of validation or invalidation about how they feel racially, and often increased pressure for explanation. For B/MR individuals, stress has been identified as a critical mediator in their health outcomes as it is related to their identification throughout numerous studies [7, 22].
This has been proven to be especially true when one’s self-identity is misaligned with the outside perception of their identity proving problematic as this is a common issue within this population and can lead to feelings of disconnectedness and lower levels of psychological well-being [7]. For multiracial individuals, imposter syndrome can affect identity.
As demonstrated in Fig 1, all of these factors play a role together in forming one’s identity and resulting behaviors, particularly as it relates to their B/MR identity. For example, the intersectionality of identity and behavior as it relates to colorism can be found between genetics and their environment. Genetic makeup contributes to how an individual looks externally, and the external environment judges and stereotypes individuals based on their looks. Culture and heritage find an intersection with the environment when behaviors that are based on traditions and cultural beliefs are impacted by White assimilation. It can be difficult to maintain cultural behaviors, especially from a minority group, in the midst of attempting assimilation towards Whiteness, in order to have an easier time entering the workforce through internships, and beginning to work in their fields. The intersectionality between genetics with culture and heritage can relate to general appearance and behaviors that have roots in tradition, or if an individual will be accepted into the culture based on their appearance. This can include cultural attire, as well as societal issues such as colorism. Lastly, there are certain expectations of physical appearance within certain racial, cultural, or ethnic groups. These can be harmful to B/MR individuals as their physical appearances may not align with members of either group that contributed to their genetic makeup, making it more difficult to be or feel included in traditions of their culture or heritage. Ultimately, these three concepts can work together or independently of one another in order to influence or affect the behavior of a person who identifies as B/MR.