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The Robert Wood Johnson Foundation (RWJF) has a vision to build a Culture of Health (CoH) by making health a shared national priority, one valued and advanced by multiple stakeholders across all sectors of society. This vision embraces a very broadly integrated and comprehensive approach to health, one where well-being lies at the center of every aspect of American life. In 2014, the RWJF commissioned NORC at the University of Chicago to plan and conduct the first American Health Values Survey (AHVS) to understand the extent to which United States adults held views consistent with this vision. The idea was to explore which types of United States adults were more supportive and less supportive of the goal and what the differences were between the more and less supportive groups. To aid in the understanding of these differences, NORC developed a typology of United States adults based on their values and beliefs related to the CoH vision.

Using a large-scale national survey fielded in late 2015 and early 2016, NORC identified six major segments of the population of adults in the United States based on their differing health values and beliefs and developed detailed profiles of each segment that described their pattern of values and beliefs as well as their demographic, political and other characteristics. NORC subsequently replicated the typology development work in five RWJF Sentinel Communities across the nation and also developed a typology of rural America. The same segments, or similar ones, were common across various geographic areas of the United States. Four years have since passed, in which changes occurred in the country. RWJF in 2019 commissioned NORC to conduct a second national, cross-sectional survey (AHVS II) in late 2019 and early 2020.

The National Lawful Use of Guns Survey is a baseline internet-based survey of 2,086 gun owners who were surveyed in 2019 and again one year later. The survey measured a wide range of variables, including: (a) psychographics; (b) firearm-related knowledge, beliefs, attitudes, practices, and norms; (c) a wide range of personal values; (d) level of engagement with guns (emotional and moral attachment to guns); (e) association between firearms and personal values; (f) mindset towards firearm and other public health policies; (g) level of inclusion in or alienation from the gun control movement; and (h) level of civic engagement with gun violence prevention.

The National Lawful Use of Guns Follow-Up Survey was conducted in 2020 and sampled the same 2,086 gun owners who responded to the baseline survey. This survey tested several communication messages intended to try to increase the willingness of gun owners to participate in gun violence prevention activities.

Since 2013, the Robert Wood Johnson Foundation (RWJF) has led the development of a pioneering national action framework to advance a "culture that enables all in our diverse society to lead healthier lives now and for generations to come." Accomplishing these principles requires a national paradigm shift from a traditionally disease and health care-centric view of health toward one that focuses on well-being. Recognizing that paradigm shifts require intentional actions, RWJF worked with RAND researchers to design an actionable path to fulfill the Culture of Health (CoH) vision. A central piece of this work is the development of measures to assess constructs underlying a CoH.

The National Survey of Health Attitudes (NSHA) is a survey that RWJF and RAND analysts developed and conducted as part of the foundation's CoH strategic framework. The foundation undertook this survey to measure key constructs that could not be measured in other data sources. Thus, the survey was not meant to capture the full action framework that informs CoH, but rather just selected measure areas. The questions in this survey primarily addressed the action area: making health a shared value. The survey covers a variety of topics, including views regarding what factors influence health, such as the notion of health interdependence (peer, family, neighborhood, and workplace drivers of health), values related to national and community investment for health and well-being; behaviors around health and well-being, including civic engagement on behalf of health, and the role of community engagement and sense of community in relation to health attitudes and values.

This study includes the results from the 2023 RWJF National Survey of Health Attitudes. The 2023 survey is the third wave of the NSHA. The first wave was conducted in 2015 (ICPSR 37405) and the second wave in 2018 (ICPSR 37633). The 2023 report complements the overview of the 2015 survey described in the RAND report Development of the Robert Wood Johnson Foundation National Survey of Health Attitudes (Carman et al., 2016), and its subsequent topline 2018 Survey of National Health Attitudes: Description and Top-Line Summary (Carman et al., 2019) and is organized similarly for consistency. A companion set of longitudinal surveys during the COVID-19 pandemic was fielded between 2020 and 2021 and is further described in four top-line reports, COVID-19 and the Experiences of Populations at Greater Risk (Carman et al., 2020-2021).

The questions in the 2023 survey uniquely capture aspects of American mindset about health, health equity, structural racism, and wellbeing in ways that are not present in other surveys. This version of the NSHA can be viewed in three main sections: (1) individual health experiences, perspectives, and knowledge (making health a shared value); (2) health equity perspectives; and (3) community wellbeing, including climate views and barriers to community engagement. Insights from the surveys referenced above, including this one, have established a baseline and set of cross-sectional pulse checks on where the American public is regarding their recognition of social determinants of health, their understanding of health inequities including structural racism, their willingness to address those inequities and their indication of who in society should be responsible for solving health inequities.

In 2019, RWJF commissioned the National Opinion Research Center (NORC) to survey U.S. adults and develop a typology to better understand current mindsets within the U.S. adult population related to resource problems such as: adequate incomes and access to healthy food, child-care programs, and preschool. The idea was to use a typology to understand values and beliefs related to promoting solutions to the problems, including differing views about the deservingness of low-income families, the importance of systemic-level causes, and the proper role for government to play in addressing the problems. The work was to be modeled on previous NORC American Health Values Survey work completed for RWJF.

Specific objectives of the work were to:

• Identify prevailing values and beliefs related to child and family health promotion among U.S. adults, especially those related to the causes, solutions, and impacts of important problems facing families with young children along with who should be responsible for addressing the problems.

• Better understand differences in these values and beliefs through development of a typology.

• Generate strategic insights for stakeholders working to address the important problems facing families with young children.