In the Eye of the Storm
Race and Genomics in Research and Practice
Vivian Ota Wang
Stanley Sue
The difficulties of operationalizing race in research and
practice for social, behavioral, and genetic researchers
and practitioners are neither new nor related to recent
genetic knowledge. For geneticists, the bases for under-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
standing groups are clines, observed traits that gradually
change in frequency between geographic regions without
distinct identifiable population boundaries and population
histories that carry information about the distribution of
genetic variants. For psychologists, race may not exist or
be a social and cultural construct associated with fluid
social inferences. Because definitions of populations and
race can be socially and biologically incongruent, the
authors suggest that geneticists and social and behavioral
scientists and clinicians attend to external validity issues by
operationalizing population and racial categories and
avoiding race proxies for other biological, social, and
cultural constructs in research designs, data analyses,
and clinical practice.
T
he results of genomic discovery along with the
promises of molecular medicine have energized the
cultural discourse about science and health. Al-
though confusion of this genetic twist for some people has
been a naive faith (or dread) that genetics (the study of
single genes and their effects), genomics (the study of gene
functions and interactions across the genome and environ-
mental factors; Guttmacher & Collins, 2002), and biology
are interchangeable, not all biological differences are ge-
netic. Acquired or inherited biological differences can exist
because of human population differences secondary to mi-
gration effects (e.g., genetic drifts, bottlenecks, selection)
and other factors such as occupation, nutrition, toxic expo-
sures, fetal and neonatal development, and discrimination.
To unravel the complexity of health, disease, and behav-
iors, social, behavioral, and epidemiologic scientists have
studied disease etiologies and processes by investigating
genetic, environmental, and Genetic ! Environmental in-
teractions in twin, association, and epidemiologic-based
studies, approaches used long before the advent of molec-
ular biology (e.g., Heath et al., 2002; Jinks & Fulker, 1970;
Malhotra & Goldman, 1999; Plomin & Crabbe, 2000).
Shortcomings to these approaches include false-positive
associations, recall bias, limited phenotypic and environ-
mental exposure data, ascertainment bias of more severe
cases, underrepresentation of underserved populations, and
replication problems. Although large cohort studies
January 2005 American Psychologist
Copyright 2005 by the American Psychological Association 0003-066X/05/$12.00
Vol. 60, No. 1, 37 45 DOI: 10.1037/0003-066X.60.1.37
U.S. Department of Health and Human Services
University of California, Davis
National Health and Nutrition Examination Survey
(NHANES; U.S. Department of Health and Human Ser-
vices, 1982), Framingham Heart Study (Dawber, Meadors,
& Moore, 1951; Kannel, 2004), United Kingdom Biobank
(Critchley & Capewell, 2003), and deCODE (Hakonarson,
Gulcher, & Stefansson, 2003; Nievergelt, Smith, Kohlen-
berg, & Schork, 2004) have or are being planned to
overcome some of these barriers, their use also has also
been limited by unavailable and unclear race or population
inclusion criteria that make data from these large national
data sets difficult to combine and compare (Collins, 2004).
In contrast, quantitative genetics arose in the 1920s to
examine how genetic, environmental, and Genetic ! En-
vironmental interactions vary because of evolutionary, de-
velopmental, and environmental factors. For example,
some variations (polymorphisms) in DNA sequences are
transmitted generation to generation over evolutionary time
scales, whereas some variants arose more recently. These
differences influence the quantity, timing, and effect of
protein activity during the developmental and physiologi-
cal lifetime of the individual (e.g., Gray & Thompson,
2004).
Given the increasing crossover among the genetics,
social, and behavioral research communities, the complex-
ity of health and disease processes can be better contextu-
alized and understood than previously done. Geneticists
can provide a genomic framework of mechanistic and
evolutionary explanations of health and diseases, whereas
social and behavioral scientists can examine the complex
Vivian Ota Wang, Ethical, Legal, and Social Implications Program, Na-
tional Human Genome Research Institute, National Institutes of Health,
U.S. Department of Health and Human Services; Stanley Sue, Department
of Psychology, University of California, Davis.
We thank Francis S. Collins, Lisa D. Brooks, Kevin O. Cokley,
Morris W. Foster, Mark Guyer, Jean E. McEwen, and Joseph F. Rath for
thoughtful comments on earlier versions of this article.
The views expressed in this article are those of the authors. No
official endorsement of the University of California, the National Human
Genome Research Institute, the National Institutes of Health, or the U.S.
Department of Health and Human Services is intended or should be
inferred.
Correspondence concerning this article should be addressed to Viv-
ian Ota Wang, Ethical, Legal, and Social Implications Program, National
Human Genome Research Institute, National Institutes of Health, U.S.
Department of Health and Human Services, 5635 Fishers Lane, Suite
4076, MSC 9305, Bethesda, MD 20893-9305. E-mail: otawangv@
mail.nih.gov
37

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Vivian
Ota Wang
relationships among genetics, biology, society, culture, in-
trapsychic experiences, and behaviors.
However, race, genetics, and psychology have shared
a tumultuous history (Guthrie, 1998; Jones, 1997). On the
one hand, geneticists recognize that genes act in concert
with environmental factors and that a complete understand-
ing of health, disease, and behavioral processes requires
multifactorial, multidisciplinary research designs and anal-
yses. However, they often focus their attention toward
genomics and biology, overlooking environmental, social,
cultural, and psychological factors that are rudimentary for
social and behavioral scientists. On the other hand, many
social and behavioral scientists have tended to disregard
genetics. For some, their skepticism is due to their inability
to make conceptual or theoretical connections between
human health and the in vitro and animal models often used
in genetics. Additionally, some are cautious about genetics
because of their limited knowledge of biology.
There is also nervousness about biological determin-
ism because the history of psychology awkwardly reminds
psychologists how their predecessors contributed to the
conflation of genetics and race-based phenotypes (observ-
able behaviors or traits such as intelligence and skin color)
at the expense of other explanatory mechanisms (Duster,
2003; Guthrie, 1998). Yet others are more broadly con-
cerned that focusing on genetics will divert attention from
existing research efforts investigating reasons for health
disparities by attributing poor health outcomes to genetics
and thereby overemphasizing the potential of genetic re-
search to alleviate health disparities (Sankar et al., 2004).
Overall, the confluence of race, behavior, and genetics
has been particularly contentious because misleading social
and cultural inferences about biology and race especially in
the area of behaviors (e.g., violence, intelligence, and ad-
38
dictions) have resulted in potential and real inequitable
treatment of individuals and groups. Nevertheless, the de-
bate about the biological and social meanings of race
continues (Bhopal & Donaldson, 1998; Burchard et al.,
2003; Cooper, Kaufman, & Ward, 2003; Foster & Sharp,
2002; Phimister, 2003; Risch, Burchard, Ziv, & Tang,
2002; Sankar & Cho, 2002). On the one hand, abandoning
the variable of race because it has no biological or scientific
validity has been an appealing choice for some researchers
(Haga & Venter, 2003; Schwartz, 2001). On the other hand,
if race does not exist, how are pharmacogenomic claims of
inter- and intrapopulation differences in drug metabolism
and toxicity justified (Evans & Johnson, 2001; Wilson et
al., 2001)?
To avoid unnecessary and potential harmful social or
biological exaggerations of population differences, one
needs a shared understanding of how geneticists and social
and behavioral researchers define and use the concepts of
population and race. This task is particularly difficult for
both the social and behavioral scientists who are trying to
find ways of achieving greater definitional precision of race
without undervaluing the psychological and social signifi-
cance and the geneticists who are cautious of not overes-
timating biological or genetic contributions to health and
diseases in a race-conscious society.
In this article, we describe ways geneticists and psy-
chologists understand these concepts. We propose that in-
creasing external validity, the extent to which research
results can be applied to other people beyond the popula-
tion studied (population validity) or settings (ecological
validity; Campbell & Stanley, 1963; Cook & Campbell,
1979) will provide greater methodological consistency be-
tween these research communities. Ways of defining pop-
ulation categories and research design issues that avoid
using race as proxy for other biological, social, and cultural
constructs are also discussed.
Human Genetic Variation
The human genome is organized into 23 pairs of chromo-
somes. These chromosomes carry the instructions for mak-
ing proteins. Chromosomes are made of DNA and in turn
are made of the smaller units called bases. Four bases,
adenine, thymine, cytosine, and guanine, are specifically
paired; an adenine with a thymine, and a cytosine with a
guanine to form a double-stranded helix. The human ge-
nome contains three billion base pairs and is estimated to
have 21,000 25,000 genes. The genetic sequence of any
human is estimated to be 99.9% identical to any other
unrelated person (International Human Genome Sequenc-
ing Consortium, 2004).
Of the roughly 20 million variable sites in the human
genome, the major proportion, 85%, accounts for within-
group genetic diversity, with the remaining 10% represent-
ing variation between any two geographically distinct
groups, and 5% between-groups from different continents
(Jorde, Watkins, Bamshad, Dixon, & Ricker, 2000;
Lewontin, 1972; Marth et al., 2003). This genetic variation
is indicative of recent modern human ancestry with an
initial low population size of about 20,000 people who
January 2005 American Psychologist

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Stanley
Sue
shared genetic and physiological traits because of relative
endogamy (preferential procreation of members of social
units within their own group because of social or cultural
norms) for prolonged time periods and a population expan-
sion antedating the migration of modern humans out of
Africa about 100,000 years ago (Cavalli-Sforza, Menozzi,
& Piazza, 1994).
However, cultural and geographic barriers to endog-
amy are fragile. Here, physical anthropologists and genet-
icists agree that traits (e.g., skin color) do not cluster in
rigidly bounded populations but gradually change in fre-
quency from one geographic region to another. This pattern
of continuous variation is called clinal variation (Bamshad,
Wooding, Salisbury, & Stephens, 2004). Even Charles
Darwin (1871) recognized clinal variation, noting that
there are no races without transitions to others; that every race
exhibits within itself variations of color, of hair, of feature, and of
form, to such a degree as to bridge over to a large extent the gap
that separates it from other races. It is asserted that no race is
homogeneous; that there is a tendency to vary. (p. 698)
Despite clinal variation, some human variation patterns
cluster, are more common in particular population groups,
and are biologically meaningful. For example, the ABO
blood group is polymorphic in all populations. People
belong to one of four blood types, A, B, AB, and O. Blood
types are inherited in all people and have observed popu-
lation frequency differences (e.g., in almost all populations,
Type O is the most common type, with it being particularly
common in some North and South American Indian pop-
ulations; Lewontin, 1972).
So why are some geographic regions perceived as
major human population groups? In brief, human genetic
variation patterns are influenced by population and migra-
tion history. People from local population groups are typ-
January 2005 American Psychologist
ically more closely related than are members of groups who
live greater distances apart. Some population groups arose
from a small number of people who expanded their geo-
graphic and social and cultural mores into other local and
distant populations. Because of their small numbers cou-
pled with a relatively endogamous lifestyle for large parts
of their social and cultural history, their genetic contribu-
tions have been disproportionately magnified in their pop-
ulation cluster (Cavalli-Sforza et al., 1994).
Because of migration events, biological meanings of
genetic differences have been inferred in populations
(King, 2002; Schwartz, 2001). For example, founder ef-
fects have resulted in variation in the prevalence of genetic
variants and disease alleles such as Tay Sachs in Ashkenazi
Jewish people, cystic fibrosis in people of Northern Euro-
pean ancestry (Arnason, Sigurgislason, & Benedikz, 2000;
Lucotte & Hazout, 1995), and differences among popula-
tions in the frequencies of drug-metabolizing enzymes
leading to pharmacogenomic differences among individu-
als in metabolism, efficacy, and drug toxicity (Exner, Dries,
Domanski, & Cohen, 2001).
Looks or Drops
When we talk about the concept of race, most people believe that
they know it when they see it but arrive at nothing short of
confusion when pressed to define it. (Higginbotham, 1992, p. 253)
The power of racialized thinking is derived from social
impressions that race is biological and inextricable from a
persons essential character thereby having scientific legit-
imacy (Delgado, 1995). Because ethnocentric assumptions
and stereotypes perpetuated by biology and race-based
notions have been used to justify exploitation, slavery
practices, and population stereotypes about behaviors, it is
not necessarily the physical and biological realities but the
social and personal significances attached to these features
that people find unsettling (Gould, 1994; Takaki, 1994).
Historically, race has been defined by morphological
characteristics, such as skull volume and size, skin color,
facial features, and other visible qualities that could be
metrically measured and cataloged (Gould, 1981; Guthrie,
1998). Even now, people have been shown to place inor-
dinate emphases on an overall physical gestalt of racial
characteristics (e.g., Black, White, Asian) and are often
unable to distinguish features that would help them recog-
nize as individuals people who belonged to racial groups
unlike their own (Levin, 2000). However, the practice of
classifying groups on the basis of physical features is not
new. For example, Linnaeuss (1758) Systema Naturae
categorized people by physical features and geographic
ancestry into four racial groups (Europeaus, Asiaticus,
Americanus, and Africanus).
Linnaeuss protege Blumenthal defined five races
(Caucasian, Mongolian, Ethiopian, American, and Malay)
and has been suggested by Gould (1994) as proposing a
race hierarchy of worth based on perceived beauty as
embodied in a Caucasian ideal (from the people from the
Caucasoid mountain range that lies between the Black and
Caspian seas). All of these categories have been included in
39
 nearly all subsequent race lists down to the present day
(Risch et al., 2002; Rosenberg et al., 2002; D. W. Sue &
Sue, 2003).
By the 19th century, researchers were discovering
that racial differences were biological and that morals,
physical characteristics, intellectual capacity, and social
differences were the consequence of blood or biology
(Gould, 1981; Guthrie, 1998; Smedley, 1999). Using state-
of-the-art science of the time, these researchers found
evidence in biology, craniometry (measuring skulls to as-
sign intelligence levels), anthropology, and medicine. Then
as today, researchers were unsuccessful in finding valid and
reliable population-specific metrics due to clinal and intra-
group variation. For example, skin color (Parra et al., 2003)
and ancestral geography (Bamshad et al., 2004) can be
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ambiguous proxies for genetic heritage.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Recent reports of human genetic variation research
reifying race or population clusters as naturally occurring
(Risch et al., 2002; Rosenberg et al., 2002), rather than
social and cultural constructions, has been occurring within
the context of an increasing number of behavioral genetics
claims related to mental illness (Chakravarti, 2002; Segu-
rado, 2003), behaviors (Kluger, Siegfried, & Ebstein, 2002;
McGough et al., 2002; Rhee & Waldman, 2002), and
genetic determinism. The meaninglessness of race also has
been gaining visibility in the popular and scientific press
(Harpending & Cochran, 2002; Pinker, 2002).
The issue of race and psychology again fills the pages
of the American Psychologist over a decade after Yee,
Fairchild, Weizmann, and Wyatt (1993) urged the Ameri-
can Psychological Association to address psychologys
problems with race and produce guidelines for research and
publication. Many of the barriers to understanding race
they listed still exist (e.g., inadequate definitions for race,
fears of genetic determinism, misrepresentation of genetic
information, and organizational and professional inaction).
Therefore, we believe the task before psychologists is not
to increase the length of their list or get mired in the details
of how race should be defined but to advocate for inten-
tionality and clarity when using race or population identi-
fiers in research. Questions of whether studies are unduly
racialized will largely depend on the questions being asked,
the quality of the research, and the extent to which the
conclusions can be supported. We believe the faults usually
lie in problems of external validity where research findings
and clinical applications are overgeneralized because of
vague or unclear race or population descriptions and using
race proxies in research designs, data analyses, and clinical
interventions. Psychologists are all in the eye of the storm.
Recommendations
Demographic variables are an essential and frequently un-
examined part of the clinical and research enterprises. In its
worst form, race is arbitrarily defined (if at all) and incon-
sistently used by researchers and clinicians because of their
use of unclear and interchangeable terminology such as
race, ethnicity, national origin, heritage, and ancestry.
Varying notions of what population and race represent
(e.g., biological aspects, psychological aspects, language,
40
behavior) also contribute to the confusion. Additionally,
intragroup variation is rarely measured and accounted for,
resulting in the tendency to ignore intragroup variation and
report overgeneralized group findings.
Failure to acknowledge intragroup variation can lead
to overgeneralized clinical and research conclusions and
thus problems of external validity. For example, social and
behavioral researchers and clinicians often assume sample
or group homogeneity because participants self-identify
into a single forced-choice category (e.g., Asian) making it
impossible to gauge intragroup variation. This in turn can
lead them to erroneously conclude that a universal set of
psychological qualities characterizes the population when
comparisons are significant (Betancourt & Lopez, 1993;
Zuckerman, 1990). Not only are these generalizations more
monolithic than in actuality (e.g., Asians are nonverbal and
family oriented), the conclusions drawn may bear little
resemblance to possible unmeasured proximal processes
that may better explain the observed phenomena (e.g.,
cognitive complexity/simplicity; individuation/collectiv-
ism, introversion/extroversion). This is particularly trou-
blesome given psychologists training in identifying, mea-
suring, and using proximal factors such as intrapersonal
(e.g., cognitive styles, racial identity), situational (e.g.,
family systems, socioeconomic status, racism), and affec-
tive variables (e.g., depression, anxiety) in research and
practice.
S. Sue (1999) has argued that the state of psycholog-
ical research is weakened by professional preferences and
a selective encouragement (e.g., by journal editors) of
internal validity (e.g., the confidence that causal relation-
ships can be concluded between independent and depen-
dent variables) over external validity as defining quality
research. Although both forms of validity are important and
necessary, internal validity dominates. We suggest that
internal and external validity can be balanced. Compro-
mises to research and clinical integrity need not be made if
psychologists are equally deliberative and thoughtful about
external and internal validity issues. If social and behav-
ioral researchers and clinicians continue to rely on conve-
nience sampling and disregard the importance of external
validity and population identifiers, not only will the overall
clinical utility and research quality diminish because of
intra- and intergroup variation confounds, spurious clinical
judgments and research results will contribute to fears of
genetic determinism, eugenics, and discrimination. Genet-
icists and social and behavioral clinicians and researchers
must attend to conceptual clarity by operationalizing pop-
ulation and racial categories and avoiding race proxies for
other biological, social, and cultural constructs in research
and clinical practice.
Conceptual Clarity
Researchers often assume that demographic categories
such as race reflect phenotypically identifiable and stable
qualities of people. However, great discrepancies in how
race is defined and used have made population or race-
based meta-analyses difficult. First, researchers frequently
fail to operationalize what they mean when using popula-
January 2005 American Psychologist
 tion categories. Second, because race is often used as a
proxy for other factors, it is at times unclear what the race
demographic variable is actually measuring (or not
measuring).
Self-report is one way of ascertaining ancestry or race
to define the population of interest. Research participants
are typically asked to indicate their race (and/or ethnicity)
by choosing one of a mix of options that reflect the re-
searchers notions of race, ethnicity, national origin, or
ancestry. Because a persons self-reported identity incor-
porates a complex mix of biological, cultural, psychologi-
cal, and behavioral factors not necessarily determined by
genotype or biology (Li, 2003), racial self-referents can be
highly variable and arbitrary, varying as a function of time,
history, law, politics, social context, and emotions. Conse-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
quently, a person may define and respond differently at
This document is copyrighted by the American Psychological Association or one of its allied publishers.
different times to the same questions about his or her race.
Although some genetic researchers may be using multilo-
cus genotype clustering as a way of avoiding the uncer-
tainty of a study participants self-reported identity, similar
to the forced choice of self-report, how they set their
parameters will determine the scale and number of popu-
lation clusters (Rosenberg et al., 2002).
Ancestry, based on the lineage of progenitors who are
assumed to compose lines of descent, is another population
identifier that has often been used in genetics and social and
behavioral research. Boyds (1950) forewarning more than
a half century ago about the danger of taking over the
common mans ideas of race and incorporating them into
anthropological treatises (p. 453) is particularly cogent
given that populations that participate in research studies
have been typically chosen because of convenience rather
than more technical criteria. So, is self- or investigator-
identified ancestral geography adequate as a population
identifier?
Some researchers (e.g., Cavalli-Sforza et al., 1994)
have presented dendrograms or tree diagrams equating
their genetic data to colloquially defined races and believe
that self- or investigator-identified ancestral geography is
sufficient for defining populations. Other researchers have
felt less confident of self- and investigator-identified an-
cestral geography as a proxy for population groups, espe-
cially when phenotypic overlap, increased population in-
termixing, changes of colloquial usages, and clinal and
intragroup variation decrease its theoretical and predictive
value and appeal. For a more detailed discussion of geo-
graphic ancestry, genetics, and race, see Bamshad et al.
(2004).
If researchers choose to use ancestral geography as a
strategy for defining populations, they must explicitly op-
erationalize what they mean by ancestry and geography and
clearly state their underlying assumptions. This may be
particularly relevant if the investigator is identifying how
contextual variables are cohort or multigenerational expe-
riences (e.g., access to health and mental health services in
the context of discrimination and immigration laws). For
example, given estimates that humans have been around for
approximately 100,000 200,000 years and assuming 20
years as the measure of one human generation, if a person
January 2005 American Psychologist
is to be identified by grandparental geographic ancestry,
then depending on the populations history (e.g., patterns of
migration) his or her identity may be reflective of contem-
porary temporal, geographic, political, and cultural factors
rather than biological or genetic ones.
Nevertheless, geneticists and social and behavioral
scientists and clinicians should not be discouraged and
summarily drop race as a variable or scientific term because
they believe it is hopelessly ambiguous or a politicized
descriptor of human populations. Instead, it is precisely
because researchers and clinicians are subject to the same
intentional and unintentional biases that exist in society that
they must take particular care when describing and opera-
tionalizing what they mean when using race as a research
variable or demographic descriptor. Therefore, operation-
alizing race is as an important part of the phenomenological
world of the researcher, clinician, and study participants as
the research question under investigation.
Thus, researchers and clinicians alike will need to
describe the assumptions and rationale underlying how
their population or race labels are defined and used. As
with any variable, psychologists should explain, define, and
measure how they understand the variable of race and the
rules they used to select and define the populations being
studied. These efforts should meet similar standards of
measurement and clarity as other constructs used in re-
search. Not only must researchers strive for conceptual
coherence and consistency, they will need to be thoughtful
to a priori identify and include proxy variables into their
study design or clinical judgments rather than relying on
generating post hoc hypotheses that should have been ini-
tially accounted for or measured. As in most psychosocial
research and practices, it is the psychological undercarriage
of the demographic indices (e.g., attitudes, dispositions)
that are of interest and not necessarily the biological or
social nature of the variables themselves. With this ap-
proach, investigators will be able to investigate their ques-
tions with greater scientific rigor because they will have
identified and included potential environmental and cul-
tural proxy variables as possible independent, moderating,
or mediating study variables.
Race as a Second-Order Construct
As a second-order construct, race is often used as a proxy
for assumed biological, genetic, social, psychological, and
other phenotypic factors including peoples beliefs about
ancestry, nationality, language(s)/accent, religion, skin
color, racial identity attitudes, and so forth. The danger of
using proxy variables lies in their indirect quality and
attached assumptions. For example, when Crow (2002)
recently stated that members of certain races make good
athletes but are less qualified to be physicians, he implied
athletic ability and intelligence were innate to certain pop-
ulations. Even with little to no supporting evidence that
complex traits and behaviors, such as diabetes, intelligence,
criminality, athletic ability, and so forth, are genetic, bio-
logical, or inherited (Herrnstein & Murray, 1994), these
assertions are difficult to idiomatically dispute because of
peoples social and racialized conditioning that reinforce
41
 racial stereotypes as being true. Thus, population compar-
isons often exaggerate group differences at the expense of
within-group variation and distribution overlaps. To mini-
mize this unfounded biological default, psychologists will
need to expand their research design, analyses portfolio,
and clinical decision making to include proxy variables.
So how can psychologists engage in research that
combines genetic, biologic, environmental, and intrapsy-
chic factors without perpetuating unfounded racial stereo-
types? They must begin using more multifactorial research
designs and clinical data that accommodate complex, en-
vironment, and phenotype interactions. This information
will enable researchers to realistically understand how in-
teractions among biological, social, and physical environ-
ments can affect health and disease. Additionally, because
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
of the de facto biological presumption conferred on inde-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
pendent variables in research designs, psychologists should
explore more stepwise and complex linear models and data
analyses (e.g., structural equation modeling) that use race
as a moderating and/or mediating variable instead of as an
independent variable. This will allow for a realistic account
of how population variables moderate and mediate com-
plex systems (Kraemer, Stice, Kazdin, Offord, & Kupfer,
2001). Moderators are categorical (e.g., race, sex) or con-
tinuous (e.g., income, degree of depression) variables that
affect the direction or strength of the relationship between
the independent and dependent variables and address ques-
tions of when or for whom a variable causes or predicts an
outcome. Mediators are variables that account for or ex-
plain the relationship between independent and dependent
variables and usually involve establishing how or why an
independent variable causes or predicts a criterion variable
(Baron & Kenny, 1986; Holmbeck, 1997).
Race, Genetics, and Health
Disparities
One way to investigate the issues of race is to be more
thoughtful about what race means as a distal or proximal
variable when doing research on population and health
disparities. By clarifying the roles and types of conclusions
that can be drawn, psychologists will find that interpreta-
tions of research findings will be less confusing, especially
when biological and social experiences (e.g., phenotype-
based cognitive distortions and stereotyping) are being
examined in the same research or clinical model. For
example, race often is used as a distal variable. Unlike
proximal factors that may actually be responsible for dif-
ferences (e.g., acculturation), distal variables are furthest
from the point of causation, are typically descriptive (e.g.,
race, gender), and do not directly explain an observed
phenomenon. Thus, psychologists need to understand the
research and clinical implications of using and interpreting
race as a distal variable. To do this, they need to avoid
overreliance on descriptive analyses and distal explanations
and consider more theoretically driven proximal factors.
Overall, to avoid contributing to and reifying existing
notions of race as being biological and absolute, psychol-
ogists need to explain group differences beyond simple
42
descriptive analyses. As a starting point, researchers and
clinicians who rely on self- or investigator-reported racial
categories and attribute their research findings to race or
population should clearly operationalize what they mean by
race, population, or culture and include measures about the
constructs underlying their population assumptions (e.g.,
collectivism, locus of control) rather than doing post hoc
deductions. Additionally, population-based conclusions
should be considered only when other possible proxy or
confounding factors (e.g., socioeconomic status, insurance
coverage, racial identity status) have been taken into ac-
count. Unless this is done, comparative population studies
can become particularly troublesome, as they may uninten-
tionally reify biological determinism and perpetuate un-
founded stereotypes (Beutler, Brown, Crothers, Booker, &
Seabrook, 1996).
Therefore, researchers and clinicians should not avoid
using the variable of race because race in fact is important
as a social and cultural construct. However, unless re-
searchers and clinicians use race judiciously, race can be
misleading because of varying and inconsistent definitions
and uses across studies, invalid biological or social/cultural
assumptions, and misinterpretations of the proxy and/or
distal variable(s). Although it is true that researchers and
clinicians may want to use race as a gestalt or as a term
encompassing many variables associated with the experi-
ence of racial minorities (e.g., minority group status, stigma
because of skin color, experience with prejudice and dis-
crimination, etc.), the usefulness of race as a variable is an
empirical question that should be dismantled and examined
in the following stages.
First, what is the definition and what are the advan-
tages and limitations imposed by the definition? Second,
does the variable make a difference? Third, if differences
are found, why do they exist? Are the racial explanations
consistent with what is allowable given ones definition?
Particular care must be taken to avoid using a socially
based definition and invoking a genetic explanation (or vice
versa) in the absence of strong and compelling evidence.
Additionally, if race is being examined as a proxy for other
variables, the other variables should also be studied. Thus
issues involving proxy variables, as well as moderators and
mediators, should be examined in order to explain race
effects.
Implications for Clinical Practice
The dilemmas of using race in research are similar to those
encountered in clinical, counseling, and professional prac-
tice because clinicians definitions and assumptions about
race influence diagnostics and clinical treatment plans. For
example, how do clinician and client racial identities affect
their assumptions about race? How do clients and clini-
cians racialized life experiences affect the therapeutic set-
ting and working alliance? How does a clinician compare
treatment efficacy that is found to be effective for one racial
group with another group?
Because treatment outcome disparities have been
found for clients from various racial groups, guidelines
have been established by the American Psychological As-
January 2005 American Psychologist
 sociation (2002) to address how clients should be consid-
ered within their racial and cultural context and how cul-
turally competent skills should be acquired by clinicians. In
particular, the guidelines raise the following important is-
sues pertinent in our discussion of professional practice and
race:
1. Clinicians usually infer a clients racial group mem-
bership on the basis of their personal judgment of the
clients physical appearance or by the clients self-report.
Of critical importance is the clinicians ability to evaluate
the clients psychological and pragmatic experiences of
being a member of a racial group. Just as researchers
should understand the meaning of race in research studies,
clinicians should understand what race means for their
clients.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
2. Understanding the meanings of race is critical for
This document is copyrighted by the American Psychological Association or one of its allied publishers.
clinicians. Instead of solely placing race as belonging to
their clients, clinicians must also be self-reflective of how
their own racialized experiences have influenced their at-
titudes and behaviors toward similar and different racial
groups compared with their own.
3. Although most clinicians are unlikely to consider
overt client behaviors, attitudes, and values as genetically
or biologically determined, their dependence on cultural
issues as explaining behaviors may pose specific difficul-
ties. On the one hand, some clinicians may be prone to
overgeneralizations, racial mythology, and stereotyping be-
cause they overemphasize cultural influences at the ex-
pense of within-group heterogeneity (e.g., Asians are non-
verbal and avoid eye contact). On the other hand, other
clinicians may decontextualize their clients by deempha-
sizing race and culture as relevant by treating them as
generic humans or individuals in diagnostics and treatment
planning. Thus, the task for clinicians is to appreciate the
importance of race and culture and to determine how racial
and cultural factors operate and influence the treatment
context and their clients mental health.
4. In the mental health treatment context, it is impor-
tant to examine social, political, and racial group status.
Culture refers to the behavior patterns, symbols, institu-
tions, attitudes, values, and human products of a group or
society. Minority group status is a persons or groups
position or power status. For example, racially identified
minority groups such as people of African descent may
have cultural behavioral patterns that reflect not only their
culture but also a social and political reaction to a history
of prejudice and discrimination. Thus, clinicians must be
informed of their clients and own overt and covert cul-
tural, social, and political histories that may augment or
jeopardize therapeutic alliances especially in treatment
interactions.
5. In research as well as when applied in clinical
settings, race when used as a demographic variable is often
used as a proxy for presumed cultural or minority group
experiences. Clinicians will need to distinguish and more
precisely understand racial, cultural group experiences of
clients.
6. Clinicians should be aware that research on the
effectiveness of treatments has been primarily conducted
January 2005 American Psychologist
on U.S. middle-class people of European ancestry. Al-
though the treatments may well be effective with different
populations, until research clearly demonstrates their effec-
tiveness with different populations, clinicians should apply
these interventions judiciously.
Final Thoughts
How we define and discuss race has major biomedical,
psychosocial, and public health implications. Genetic, so-
cial, and cultural interpretations of population and social
histories can be used in ways that intentionally or uninten-
tionally lead to genetic discrimination, stigmatization, and
missed or delayed diagnoses. To these ends, how social,
behavioral, and genetic scientists and health service pro-
viders understand how racism and race are used in research
and practice continues to be investigated (Clark, Anderson,
Clark, & Williams, 1999; Krieger, Sidney, & Coakley,
1998; Mays, Ponce, Washington, & Cochran, 2003; U.S.
Department of Health and Human Services, 2001a, 2001b).
Overall, geneticists and social and behavioral scien-
tists and clinicians must recognize how their own unclear
use of race creates havoc for scientific, clinical, and health
policy enterprises. For example, identifying groups as pos-
sessing unsubstantiated genetic, biological, social, or be-
havioral characteristics can encourage erroneous assump-
tions and stereotyping with pseudobiopsychosocial
precision. We must take responsibility for not perpetuating
ethnocentric assumptions clothed as scientific questions
(Gould, 1981).
For psychologists, covertly accepting a de facto bio-
logical imperative about race in research designs, data
analyses, and clinical applications and using race as a
proxy for other variables may continue to distract research
and clinical efforts away from relevant variables that may
be pivotal in understanding people within their social,
cultural, genetic, and environmental contexts. Adequate
consideration of psychological, social, cultural, and politi-
cal variables is critical for the successful integration of
social, behavioral, and genetic information for research and
practice.
At some level, the current state of genetic research
allows the study of diseases in enough detail to move
beyond the naturenurture debate. It is now clearer how
DNA is both inherited and environmentally responsive. In
many ways, a persons attitudes and behaviors orchestrate
the interplay between inherited and environmental changes
on the genome. One way geneticists and social and behav-
ioral scientists can begin collaborating is to develop inter-
disciplinary approaches to the study of race and health. For
instance, the National Institutes of Healths roadmap initi-
atives for research are examples of removing barriers to
interdisciplinary research by encouraging collaborations in
the development and implementation of long- and short-
term training programs and curriculum development that sup-
port interdisciplinary research training for investigators at all
career levels. These efforts include exploratory centers for
interdisciplinary research; training for a new interdisciplinary
research workforce; supplements for methodological innova-
tions in the behavioral and social sciences; interdisciplinary
43
 health research training in behavior, environment, and bi-
ology; and curriculum and methodological development in
interdisciplinary research (see http://nihroadmap.nih.gov/).
Forty years ago, Snow (1964) described an abyss
between the natural sciences and humanities (and social
and behavioral sciences) as two cultures and bemoaned the
inability of members of either to communicate effectively
with one another. He also suggested that molecular biology
could be the bridge between the two cultures because this
branch of science is likely to affect the way in which men
[and women] think of themselves more profoundly than
any scientific advance since Darwinsand probably more
so than Darwin (p. 74). What Snow may not have envi-
sioned was the extent to which genetics would provide
tools to help address questions posed by social and behav-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ioral scientists.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
To this end, we hope that more social and behavioral
scientists will take up the challenge and investigate the
relationships among genes, populations, and behavior. Ge-
netic differences exist among individuals, and small differ-
ences can have large effects on phenotypes and disease
risk. Additionally, populations differ in the frequencies of
many variants, and these can interact with environmental
variables to contribute to differences in disease prevalence.
Until population (and race) variables are more methodolog-
ically robust and used more consistently, social, behavioral,
and genetic research will be limited in answering questions
related to biological and psychological differences, treat-
ment efficiency, diagnostic bias, and service delivery.
Regardless of whether scientists believe race is real or
just skin deep, race is personally, socially, and politically
important to millions of people who have nothing to do
with our scientific enterprise. Thus, perhaps the biggest
challenge for understanding genetics and race for psychol-
ogists will be to disentangle not just the correlations of race
with genetic variation and environmental exposures but
adding the psychological and social factors to understand
the complexity of health and disease processes. If improved
health is the objective, efforts should be placed where the
problems really lie.
REFERENCES
American Psychological Association. (2002). Guidelines on multicultural
education, training, research, practice, and organizational change for
psychologists. Washington, DC: Author.
Arnason, E., Sigurgislason, H., & Benedikz, E. (2000). Genetic homoge-
neity of Icelanders: Fact or fiction? Nature Genetics, 25, 373374.
Bamshad, M., Wooding, S., Salisbury, B. A., & Stephens, J. C. (2004).
Deconstructing the relationship between genetics and race. Nature
Reviews Genetics, 5, 598 609.
Baron, R. M., & Kenny, D. A. (1986). The moderatormediator variable
distinction in social psychological research: Conceptual, strategic, and
statistical considerations. Journal of Personality and Social Psychol-
ogy, 51, 11731182.
Betancourt, H., & Lopez, S. R. (1993). The study of culture, ethnicity, and
race in American psychology. American Psychologist, 48, 629 637.
Beutler, L. E., Brown, M. T., Crothers, L., Booker, K., & Seabrook, M. K.
(1996). The dilemma of factitious demographic distinctions in psycho-
logical research. Journal of Counseling and Clinical Psychology, 64,
892902.
44
Bhopal, R., & Donaldson, L. (1998). White European, Western, Cauca-
sian, or what? Inappropriate labeling in research on race, ethnicity, and
health. American Journal of Public Health, 88, 13031307.
Boyd, W. C. (1950). Genetics and the races of man: An introduction to
modern physical anthropology. Boston: Little, Brown.
Burchard, E. G., Ziv, E., Coyle, N., Gomez, S. L., Tang, H., Karter, A. J.,
et al. (2003). The importance of race and ethnic background in bio-
medical research and clinical practice. New England Journal of Medi-
cine, 248, 1170 1175.
Campbell, D. T., & Stanley, J. (1963). Experimental and quasi-experi-
mental designs for research. Chicago: Rand-McNally.
Cavalli-Sforza, L. L., Menozzi, P., & Piazza, A. (1994). The history and
geography of human genes. Princeton, NJ: Princeton University Press.
Chakravarti, A. (2002). A compelling genetic hypothesis for a complex
disease: PRODH2/DGCR6 variation leads to schizophrenia suscepti-
bility. Proceedings of the National Academy of Sciences, USA, 99,
4755 4756.
Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999).
Racism as a stressor for African Americans: A biopsychosocial model.
American Psychologist, 54, 805 816.
Collins, F. C. (2004, May 27). The case for a US prospective cohort study
of genes and environment. Nature, 429, 475 477.
Cook, T. D., & Campbell, D. T. (1979). Quasi-experimentation: Design
and analysis issues for field settings. Boston: Houghton Mifflin.
Cooper, R. S., Kaufman, J. S., & Ward, R. (2003). Race and genomics.
New England Journal of Medicine, 348, 1166 1170.
Critchley, J. A., & Capewell, S. (2003). Prospective cohort studies of
coronary heart disease in the UK: A systematic review of past, present
and planned studies. Journal of Cardiovascular Risk, 10, 111119.
Crow, J. F. (2002, Winter). Unequal by nature: A geneticists perspective
on human differences. Daedalus, 81 88.
Darwin, C. (1871). The descent of man and selection in relation to sex.
London: J. Murray.
Dawber, T. R., Meadors, G. F., & Moore, F. E. J. (1951). Epidemiological
approaches to heart disease: The Framingham Study. American Journal
of Public Health, 41, 279 286.
Delgado, R. (Ed.). (1995). Critical race theoryThe cutting edge. Phil-
adelphia: Temple University Press.
Duster, T. (2003). Backdoor to eugenics (2nd ed.). New York: Routledge.
Evans, W. E., & Johnson, J. A. (2001). Pharmacogenomics: The inherited
basis for interindividual differences in drug response. Annual Review of
Genomics and Human Genetics, 2, 9 39.
Exner, D. V., Dries, D. L., Domanski, M. J., & Cohen, J. N. (2001). Lesser
response of angiotensin-converting-enzyme inhibitor therapy in black
as compared with white patients with left ventricular dysfunction. New
England Journal of Medicine, 344, 13511377.
Foster, M. W., & Sharp, R. R. (2002). Race, ethnicity, and genomics:
Social classifications as proxies of biological heterogeneity. Genome
Research, 12, 844 850.
Gould, S. J. (1981). The mismeasure of man. New York: Norton.
Gould, S. J. (1994, November). The geometer of race. Discover, 85 89.
Gray, J. R., & Thompson, P. M. (2004). Neurobiology of intelligence:
Science and ethics. Nature Reviews Neuroscience, 5, 471 480.
Guthrie, R. (1998). Even the rat was whiteA historical view of psychol-
ogy (2nd ed.). Needham, MA: Allyn & Bacon.
Guttmacher, A. E., & Collins, F. S. (2002). Genomic medicineA
primer. New England Journal of Medicine, 347, 15121520.
Haga, S. B., & Venter, J. C. (2003, July 25). FDA races in wrong
direction. Science, 301, 466.
Hakonarson, H., Gulcher, J. R., & Stefansson, K. (2003). deCODE ge-
netics, Inc. Pharmacogenomics, 4, 209 215.
Harpending, H. C., & Cochran, G. (2002). In our genes. Proceedings of
the National Academy of Sciences, USA, 99, 10 12.
Heath, A. C., Todorov, A., Nelson, E. C., Madden, P. A. F., Bucholz, K.,
& Martin, N. G. (2002). Gene environment interaction effects on
behavioral variation and risk of complex disorders: The example of
alcoholism and other psychiatric disorders. Twin Research, 5, 30 37.
Herrnstein, R. J., & Murray, C. (1994). The bell curveIntelligence and
class structure in American life. New York: Free Press.
Higginbotham, E. B. (1992). African-American womens history and
metalanguage of race. Signs: A Journal of Women in Culture and
Society, 17, 251274.
January 2005 American Psychologist
 Holmbeck, G. N. (1997). Toward terminological, conceptual, and statis-
tical clarity in the study of mediators and moderators: Examples from
the child-clinical and pediatric psychology literatures. Journal of Con-
sulting and Clinical Psychology, 65, 599 610.
International Human Genome Sequencing Consortium. (2004, November
6). Initial sequencing and analysis of the human genome. Nature, 409,
860 921.
Jinks, J. L., & Fulker, D. W. (1970). Comparison of the biometrical
genetical, MAVA, and classical approaches to the analysis of human
behavior. Psychological Bulletin, 73, 311349.
Jones, J. M. (1997). Prejudice and racism. San Francisco: McGraw-Hill.
Jorde, L. B., Watkins, W. S., Bamshad, M. J., Dixon, M. E., & Ricker,
C. E. (2000). The distribution of human genetic diversity: A compari-
son of mitochondrial, autosomal, and Y-chromosome data. American
Journal of Human Genetics, 66, 979 988.
Kannel, W. B. (2004). Hypertension as a risk factor: The Framingham
contribution. In W. H. Birkenhager, J. I. S. Robertson, & A. Zanchetti
(Eds.), Handbook of hypertension (Vol. 22, pp. 129 142). Philadelphia:
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Elsevier.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
King, T. E. (2002). Racial disparities in clinical trials. New England
Journal of Medicine, 346, 1400 1402.
Kluger, A. N., Siegfried, A., & Ebstein, R. P. (2002). A meta-analysis of
the association between DRD4 polymorphism and novelty seeking.
Molecular Psychiatry, 7, 712717.
Kraemer, H. C., Stice, R., Kazdin, A., Offord, D., & Kupfer, D. (2001).
How do risk factors work together? Mediators, moderators, and inde-
pendent, overlapping and proxy risk factors. American Journal of
Psychiatry, 158, 848 856.
Krieger, N., Sidney, S., & Coakley, E. (1998). Racial discrimination and
skin color in the CARDIA study: Implications for public health re-
search. American Journal of Public Health, 88, 1308 1313.
Levin, D. T. (2000). Race as a visual feature: Using visual search and
perceptual discrimination tasks to understand face categories and the
cross-race recognition deficit. Journal of Experimental Psychology:
General, 129, 559 574.
Lewontin, R. (1972). The apportionment of human diversity. Evolutionary
Biology, 6, 381391.
Li, S.-C. (2003). Biocultural orchestration of developmental plasticity
across levels: The interplay of biology and culture in shaping the mind
and behavior across the lifespan. Psychological Bulletin, 129, 171194.
Linnaeus, C. (1758). Systemae naturae [The system of nature] (10th ed.).
Stockholm, Sweden: Laurentii Salvii, Holmiae.
Lucotte, G., & Hazout, S. (1995). Geographic and ethnic distribution of
the more frequent cystic fibrosis mutations in Europe show that a
founder effect is apparent for several mutant alleles. Human Biology,
67, 562576.
Malhotra, A. K., & Goldman, D. (1999). Benefits and pitfalls encountered
in psychiatric association studies. Biological Psychiatry, 45, 544 550.
Marth, G., Schuler, G., Yeh, R., Davenport, R., Agarwala, R., Church, D.,
et al. (2003). Sequence variations in the public human genome data
reflect a bottlenecked population history. Proceedings of the National
Academy of Sciences, USA, 100, 376 381.
Mays, V. M., Ponce, N. A., Washington, D. L., & Cochran, S. D. (2003).
Classification of race and ethnicity: Implications for public health.
Annual Review of Public Health, 24, 83110.
McGough, J. T., McCracken, T., MacPhie, I. L., Francks, C., Fisher, S. E.,
Cantor, R. M., et al. (2002). Genetic linkage of attention-deficit/hyper-
activity disorder (ADHD) on chromosome 16P13 in a region implicated
in autism. American Journal of Human Genetics, 71, 959 963.
Nievergelt, C. M., Smith, D. W., Kohlenberg, J. B., & Schork, N. J.
January 2005 American Psychologist
(2004). Large-scale integration of human genetic and physical maps.
Genome Research, 14, 1199 1205.
Parra, E. J., Amado, R. C., Lambertucci, J. R., Rocha, J., Antunes, C. M.,
& Pena, S. D. (2003). Color and genomic ancestry in Brazilians.
Proceedings of the National Academy of Sciences, USA, 100, 177182.
Phimister, E. G. (2003). Medicine and the racial divide. New England
Journal of Medicine, 348, 10811082.
Pinker, S. (2002). The blank slate: The modern denial of human nature.
New York: Viking.
Plomin, R., & Crabbe, J. (2000). DNA. Psychological Bulletin, 126,
806 828.
Rhee, S. H., & Waldman, I. D. (2002). Genetic and environmental
influences on antisocial behavior. A meta-analysis of twin and adoption
studies. Psychological Bulletin, 128, 490 529.
Risch, N., Burchard, E., Ziv, E., & Tang, H. (2002). Categorization of
humans in biomedical research: Genes, race, and disease. Genome
Biology, 3(7), 112.
Rosenberg, N. A., Prichard, J. K., Weber, J. L., Cann, H. M., Kidd, K. K.,
Zhlvotovsky, L. A., & Feldman, M. W. (2002, December 20). Genetic
structure of human populations. Science, 298, 23812385.
Sankar, P., & Cho, M. K. (2002, November 15). Genetics: Toward a new
vocabulary of human genetic variation. Science, 298, 13371338.
Sankar, P., Cho, M. K., Condit, C. M., Hunt, L. M., Koenig, B., Marshall,
P., et al. (2004). Genetic research and health disparities. Journal of the
American Medical Association, 291, 29852989.
Schwartz, R. S. (2001). Racial profiling in medical research. New England
Journal of Medicine, 244, 13921393.
Segurado, R. (2003). Genome scan meta-analysis of schizophrenia and
bipolar disorder, Part III: Bipolar disorder. The American Journal of
Human Genetics, 73, 49 62.
Smedley, A. (1999). Race in North America: Origin and evolution of a
worldview (2nd ed.). Boulder, CO: Westview Press.
Snow, C. P. (1964). The two cultures and a second look. New York:
Cambridge University Press.
Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse. New
York: Wiley.
Sue, S. (1999). Science, ethnicity, and biasWhere have we gone wrong?
American Psychologist, 54, 1070 1077.
Takaki, R. (1994). A different mirrorA history of multicultural America.
New York: Little, Brown.
U.S. Department of Health and Human Services. (1982). A statistical
methodology for analyzing data from a complex survey: The first
National Health and Nutrition Examination Survey (DHHS Publication
No. PHS 82-1366). Hyattsville, MD: U.S. Department of Health and
Human Services Public Health Service, Office of Health Research,
Statistics, and Technology, National Center for Health Statistics.
U.S. Department of Health and Human Services. (2001a). Mental health:
Culture, race, and ethnicityA supplement to Mental health: A report
of the Surgeon General [Executive summary]. Rockville, MD: Author.
U.S. Department of Health and Human Services. (2001b). Mental health:
Culture, race, and ethnicityA supplement to Mental health: A report
of the Surgeon General [Full report]. Rockville, MD: Author.
Wilson, J. F., Weale, M. E., Smith, A. C., Gratrix, F., Fletcher, B.,
Thomas, M. G., et al. (2001). Population genetic structure of variable
drug response. Nature Genetics, 29, 265269.
Yee, A. H., Fairchild, H. H., Weizmann, F., & Wyatt, A. E. (1993).
Addressing psychologys problems with race. American Psychologist,
48, 11321140.
Zuckerman, M. (1990). Some dubious premises in research and theory on
racial differencesScientific, social, and ethical issues. American Psy-
chologist, 45, 12971303.
45