This study examines the mental health significance of Barack Obama’s 2008 presidential election for black adults. His election was a milestone moment. Hence, we expect black adults would experience improved mental health after the first self-identified black person wins election to the most powerful position in the United States. Using nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS), we address this expectation by predicting poor mental health days that black adults report preelection and postelection. We find no overall difference in poor mental health days between the time periods. However, a statistical interaction between gender and time period demonstrates black men report 1.01 fewer poor mental health days after the election, whereas black women report .45 more poor mental health days after the election.

Empirical Evidence of Symbolic Empowerment To our knowledge, no studies theorize symbolic empowerment as we do here. Hence, we craft hypotheses by reviewing studies showing sociopolitical context matters for health and, while doing so, attempt to validate symbolic empowerment. For example, using nationally representative panel survey data spanning 13 years and overlapping with Jesse Jackson’s 1988 presidential campaign, Jackson and colleagues (1996) found black adults’ views of racial progress improved, and they reported reduced levels of psychological distress and physical health disability around 1988. The authors attributed this pattern to Jesse Jackson’s visibility and campaign message promoting social justice. We think they captured evidence supporting symbolic empowerment using time period. Showing the power of symbolic disempowerment using time period, Lauderdale (2006) considered whether increases in exposure to interpersonal discrimination among those perceived as Arab showed health significance following the 9/11 attacks. She used California birth certificate data for 2000, 2001, and 2002 to determine the relative risk of poor birth outcomes by race, ethnicity, and nativity for women who gave birth in the six-month time period following 9/11, compared to the same six-month time period one year earlier. Findings showed the relative risk of poor birth outcomes was significantly elevated but only among Arabic-named women. Krieger (2012) specified symbolic empowerment as the intersection of time period and context. She found white populations experienced the lowest mortality rates between 1960 and 1970 when they lived within (former) Jim Crow states. This finding suggests legacies of inequality can symbolically empower and protect whites. Finally, LaVeist (1992) studied black political power and postneonatal mortality rates in 176 central cities across 32 states. He operationalized black political power as proportion black on the city council divided by proportion black in the voting-age population. Results show cities with high black political power experienced low black postneonatal mortality rates. We think increases in black political power can be an indicator of symbolic empowerment. The studies we reviewed confirm sociopolitical context can influence health. However, they focus almost entirely on physical health outcomes (two focus on birth outcomes) and do not flesh out exactly why symbolic empowerment might matter. Therefore, we examine mental health and propose symbolic empowerment manifests health significance during time periods when the sociopolitical context shifts.

Study Contributions This study makes several novel contributions. First, symbolic empowerment is a theoretical framework capturing a way to estimate variability in the health significance of racism. Second, many sociological health studies rely on the stress process model (Pearlin 1989; Pearlin et al. 1981; Turner 2013), which is an individual-level framework theorizing why certain negative experiences arising from the routine circumstances of life overwhelm an individual’s capacity to respond. In contrast, symbolic empowerment is an ecological framework describing how shifts in the sociopolitical context hypothetically protect population health and, in this case, the health of black adults. Third, we address how sociopolitical context matters beyond policy development. We describe why dialectic shifts between social progress and regression might matter for aggrieved groups. Fourth, we analyze nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS) and investigate black adults’ mental health before and after November 4, 2008. Our design could be replicated to examine other shifts in the sociopolitical context because BRFSS collects data year-round and has done so since 1984. Analyses reveal no significant overall difference in poor mental health days among black adults preelection and postelection. Thus, Hypothesis 1 is not supported. However, compared to preelection, black men experience significantly fewer poor mental health days postelection, whereas black women experience no significant change in their poor mental health days postelection. Thus, Hypothesis 2 is supported. In the discussion, we elaborate symbolic empowerment as a theoretical framework and advance four potential explanations for black women’s null results. We conclude by encouraging researchers to investigate the health significance of shifts in the sociopolitical context.

Methods Data We analyzed nationally representative survey data from the 2008 and 2009 BRFSS. The BRFSS is this nation’s premier system of health-related telephone surveys and collects data year-round from adults regarding their risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS currently collects data in 50 U.S. states, the District of Columbia, and three U.S. territories. BRFSS completes more than 400,000 survey interviews each year, making it the largest continuously conducted health surveillance system in the world. For more information about the BRFSS or to access the BRFSS questionnaires or survey data, visit https://www.cdc.gov/brfss/index.html. The available sample included self-identified black adults participating in the 2008 or 2009 BRFSS (N = 69,304). Because we aimed to isolate a contemporaneous and short-lived effect of Barack Obama’s presidential election on November 4, 2008, we restricted the available sample. Specifically, we included black adults (N = 5,521) who were surveyed during one of two time periods: October 5, 2008, to November 3, 2008 (i.e., a 30-day period before the election), or December 4, 2008, to January 2, 2009 (i.e., a 30-day period that starts 30 days after the election). The second time period started 30 days after the election to accommodate an incubation interval, which permits significance of the election result to concretize. In addition, the second time period started 30 days after the election to account for the dependent variable’s “during the past 30 days” framing, thereby strengthening potential causal claims. Figure 1 graphically displays the preelection and postelection time periods and incubation interval. Finally, we kept respondents with complete information on study variables, resulting in an estimation sample size of 4,396. Download Open in new tab Download in PowerPoint Measures Number of poor mental health days reported during the past 30 days (range = 0–30) was the outcome. The question read: “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 primary predictor was whether the survey interview occurred during one of two time periods: October 5, 2008, to November 3, 2008 (i.e., a 30-day period before the election), or December 4, 2008, to January 2, 2009 (i.e., a 30-day period that starts 30 days after the election). We treat the time periods as a control condition and an experimental condition, respectively, with the exposure being Barack Obama’s 2008 presidential election on November 4, 2008. Control variables were established social determinants of health. For example, sociodemographic controls included: gender (i.e., men, women), age (range = 18–96 years), number of children in household (range = 0–9), and marital status (i.e., married, formerly married, never married, unmarried couple). Socioeconomic controls included: education (i.e., less than high school, Grade 12 or GED, some college, college or more), total household income (i.e., less than $25,000, $25,000–$49,999, $50,000–$74,999, and $75,000 and greater), and employment status (i.e., paid employment, retired, unable to work, other). We also controlled for whether respondents lived in a state where Barack Obama won or lost the majority of votes (i.e., “blue state” or “red state,” respectively). Information regarding which 2008 presidential candidate received the most votes by state was retrieved from the New York Times 2008 Presidential Election Results page (New York Times 2008). Finally, we modeled state as a random variable to adjust for shared variance among respondents occurring because they reside in the same state. Analytic Strategies BRFSS respondents are randomly and continuously surveyed across an entire calendar year. Respondents have the same probability of being contacted any day of the calendar year, barring major holidays. We treat this feature of the BRFSS design as a form of randomization. Presumably, any unmeasured characteristics (e.g., optimism, poor mental health, and political orientation) are distributed randomly across the two time points. Data in the estimation sample come from all 50 states. We present unweighted analyses treating the two time periods as representing quasi-experimental assignment. Patterns in Table 1, where study variables do not differ significantly preelection and postelection, support treatment of the two time periods as representing a control condition and an experimental condition, respectively. Item nonresponse was low (i.e., on average, 2.6 percent per variable), but after listwise deletion, the estimation sample was 4,396. Missing cases should not affect the results because they ought to be distributed randomly across the two time periods. In Table 1, we generated descriptive statistics for the full sample and stratified by whether the survey interview occurred preelection or postelection. In Table 2, we presented estimates from regression models. Because the dependent variable originates from a count probability distribution with overdispersion and because we control for a second-level factor (i.e., state), we applied random effects negative binomial regression. To address Hypothesis 1, Model 1 in Table 2 includes time period and the control variables. To address Hypothesis 2, Model 2 in Table 2 includes a statistical interaction between gender and time period, and the control variables. All analyses were conducted in Stata 15.1, and the command file is available on request. Table 1. Descriptive Statistics on Black Adults Surveyed in the Behavioral Risk Factor Surveillance System (BRFSS) during Time Periods before and after Barack Obama’s 2008 Presidential Election. View larger version Table 2. Estimates from Random Effects Negative Binomial Regressions Predicting Poor Mental Health Days among Black Adults Surveyed in the Behavioral Risk Factor Surveillance System (BRFSS) during Time Periods before and after Barack Obama’s 2008 Presidential Election. View larger version

Results Table 1 displays descriptive statistics for the study variables among respondents in the full sample and stratified by time period. More respondents (2,475 versus 1,921 respectively) were interviewed from October 5, 2008, to November 3, 2008 (i.e., a 30-day period before the election), than from December 4, 2008, to January 2, 2009 (i.e., a 30-day period that starts 30 days after the election). This was due to fewer people being interviewed around the Christmas and New Year holidays. Table 1 also demonstrates that the study variables’ distributions were statistically identical across the two time periods. The only exception was the proportion of respondents earning more than $75,000. It was higher postelection (15.3 percent) compared to preelection (12.4 percent) and could be due to year-end bonuses, but we cannot determine whether that is the case with these data. Table 1 shows black adults reported around four poor mental health days, on average, during the past 30 days. Respondents were about 51 years old. Two-thirds of respondents were black women, and most respondents reported being married (34.0 percent) or formerly married (38.1 percent). In terms of socioeconomic status, more than a third of respondents had earned a high school degree or GED (33.7 percent), followed by some college (28.6 percent) and then a college degree (24.2 percent). Almost half the respondents earned less than $25,000 per year; just over half were employed. Finally, 60.9 percent of respondents lived in a state where Barack Obama won the majority of votes in fall 2008 (i.e., a blue state). Table 2 presents estimates from random effects negative binomial regression models. Model 1 shows that compared to black men, black women reported significantly more poor mental health days (incidence rate ratios [IRR] = 1.34, p < .05). Each year increase in age associated with a reduction in the rate of poor mental health days. Children, marital status, and education were not linked statistically with poor mental health days, whereas high income and paid employment predicted a smaller rate of poor mental health days. Contrary to Hypothesis 1, respondents interviewed preelection reported a similar number of poor mental health days compared to those interviewed postelection. Finally, living in a blue state versus red state was a nonsignificant correlate of mental health. In analyses not shown, we reran Table 2’s Model 1 regressions excluding swing states, and results were substantively unchanged. For Hypothesis 2, we explored whether gender moderated the association between symbolic empowerment and poor mental health days. We wanted to know if black men gained more than black women from Barack Obama’s 2008 presidential election. Therefore, in Model 2, we introduced a statistical interaction between gender and time period. It was statistically significant (IRR = 1.46, p < .05) and indicated the gender difference in poor mental health days was 46 percent larger postelection compared to preelection. The interaction along with main effects for gender and time period confirms that preelection, black men and women reported comparable poor mental health days. Postelection, however, black men reported significantly fewer poor mental health days compared to black women. Further, the number of poor mental health days did not differ significantly by time period for black women. To sum, black women remained at steady state, whereas black men reported fewer poor mental health days. To facilitate interpretation of the statistical interaction between gender and time period, we graphed it in Figure 2. It shows that preelection, black men reported 4.04 poor mental health days, whereas postelection, they reported 3.03 days. In contrast, preelection, black women reported 4.60 poor mental health days, whereas postelection, they reported 5.05 days. The net postelection gender disparity equals 2.02 days. However, black men preelection, black women preelection, and black women postelection reported statistically comparable numbers of poor mental health days (see Figure 2). Download Open in new tab Download in PowerPoint Sensitivity Analysis We conducted sensitivity analysis to corroborate the results. First, we addressed whether the dependent variable’s coding influenced the findings. The reported results do not differ substantively if we model poor mental health days as a categorical variable. Second, we addressed whether Barack Obama’s 2008 presidential election would mean more to older blacks who lived during Jim Crow. Specifically, we explored a statistical interaction involving time period and age. It was not statistically significant. Third, we addressed whether a granular measurement of time mattered. We coded time as a discrete numeric predictor (i.e., −30 to −1 through 1 to 30, representing days before and after the election date, respectively, with an incubation interval) but observed no statistically significant results. When modeling time as a discrete numeric predictor, we also fit cubic splines to assess nonlinear patterns, but the splines were not statistically significant. Fourth, we addressed whether black men typically experience decreased poor mental health days around the winter holidays. With black adults, we replicated analyses reported in Table 2 for identical time periods in fall 2007 and found no statistically significant interaction between gender and time period. Finally, we replicated the analyses with whites in fall 2008 and found no statistically significant results. Null findings for whites confirm that symbolic empowerment related to Barack Obama’s 2008 presidential election was specific to black men.

Future Research and Limitations This is the first study to examine systematically the mental health significance for black adults of Barack Obama’s 2008 presidential election. Moreover, this study’s limitations provide a roadmap for future research. First, BRFSS data include additional health outcomes. For example, scholars could investigate whether symbolic empowerment operates salubriously for black adults’ physical health. Second, the BRFSS fields a Reactions to Race Module. This module contains a measure of racial salience. Racial salience is the degree to which individuals think regularly about their race (Avery et al. 2004; Stryker and Serpe 1994). The module is administered infrequently and in very few states. However, it could provide evidence that Barack Obama’s 2008 presidential election caused black adults to think more regularly about being black and that, in turn, showed health significance. Third, there are other noteworthy dates from Barack Obama’s 2008 campaign. For example, he declared his candidacy on February 10, 2007. On March 18, 2008, Obama condemned Reverend Jeremiah Wright’s sermons. As a final example, his inauguration was on January 20, 2009. Future studies of symbolic empowerment could examine those dates. Fourth, self-report measures are subject to present state bias. That means respondents feeling awful might overreport poor mental health days, whereas those feeling wonderful might underreport the same. But this bias should be distributed randomly across the two time periods (see Analytic Strategies). Fifth, universal exposure to Barack Obama’s 2008 presidential election disqualifies statistical techniques that can isolate a causal effect (e.g., propensity score methods or difference in differences modeling). Related, it would be ideal to investigate symbolic empowerment and mental health using longitudinal data collected from the same individuals preelection and postelection. To our knowledge, no such data exist, and BRFSS data are the best available substitute. Sixth, BRFSS data suffer from coverage bias, as do all community-based social surveys. For example, black men who completed survey interviews are probably well off. However, black men not included typically in community-based social surveys, such as those who are incarcerated, in the military, or away at college/university, would be ideal for examining whether the impact of symbolic empowerment generalizes. Might black-on-black violence in jails and prisons have decreased because of Barack Obama’s 2008 presidential election? Or might the number of black men who enlisted into the military have increased in the 30-day time period following his election compared to the same 30-day time period a year prior? Or might his election have improved the academic performance of black men attending historically black colleges and universities (HBCUs)? Such research questions deserve attention. Seventh, in the introduction, we described how sociopolitical climate shows health significance via policy development. Work on policy and health must continue (see Salas et al. 2013; Solazzo et al. 2018; Toomey et al. 2014; Wilson 2012). For instance, Hatzenbuehler et al. (2017) found Latinos living in states with more restrictive immigration policies experienced poor mental health. Eighth, Barack Obama’s 2008 presidential election may show differential mental health significance for subgroups in the black population (e.g., sexual minorities, Republicans, or immigrants). Finally, Barack Obama’s 2008 presidential election may demonstrate the strongest mental health significance for youth who are generally more optimistic about race relations.

Acknowledgements The first author thanks Verna Keith, Dawne Mouzon, Whitney Pirtle, Jaime Slaughter-Acey, Sherrill Sellers, and Louis Woods for their contributions to this study. The second author was supported in part by a grant from the National Cancer Institute (T32CA009001). All authors thank members of the Racism and Racial Experiences (RARE) Workgroup and the Sociologists Talking about Population Health (STAPH) lab group at Rice University for their critical feedback on an early manuscript draft and perpetual encouragement. Findings herein were presented at the 2019 annual conference of the Association of Black Sociologists.

Author’s Note

This version has been updated since the initial version to reflect the author’s intended word choice of “causal” rather than ’casual” in the following sentence: Fifth, universal exposure to Barack Obama’s 2008 presidential election disqualifies statistical techniques that can isolate a casual effect (e.g., propensity score methods or difference in differences modeling).