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The Forces of Change Survey is an annual survey completed by the state and territorial health agencies that comprise the membership of the Association of State and Territorial Health Officials (ASTHO). ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. territories and freely associated states, and the District of Columbia, and the over 100,000 public health professionals these agencies employ. The Forces of Change Survey primarily focuses on emergent and rapidly changing trends. The data collected sought to determine the current climate at state and territorial health agencies as it related to budget, workforce, accreditation, and special interest topics. The 2017 Forces of Change Survey examined the following topics:

• Health agency resources
• Activities related to the Zika virus
• Opioid epidemic response
• Communicating the value of public health
• Efforts to advance health equity

The web-based survey, fielded by ASTHO in May of 2017, was administered to state and territorial health agencies through their senior deputies. A total of 52 health agencies responded (from 46 states, Washington, D.C., and five territories and freely associated states). Data included as part of this collection includes one dataset with 122 variables for 52 cases.

The 2012 ASTHO Profile Survey is a survey conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The survey aims to define the scope of state and territorial public health services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The 121-question instrument was disseminated electronically in October 2012 and completed by senior deputies at each S/THA. The survey closed in May 2013; the response rate was 96 percent among the 50 states and D.C., and 92 percent among all states, territories, and freely associated states.

Changes may be made to the dataset after it is archived. Please contact [email protected] to request the most updated datasets. Additional information on the study can be found by visiting the ASTHO Profile Survey website.

The 2016 ASTHO Profile Survey is a survey conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The survey aims to define the scope of state and territorial public health services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The 129-question instrument was disseminated electronically in April 2016 and completed by senior deputies at each S/THA. The survey closed in September 2016; the response rate was 98 percent among the 50 states and D.C., and 97 percent among all states, territories, and freely associated states.

Changes may be made to the dataset after it is archived. Please contact [email protected] to request the most updated datasets. Additional information on the study can be found by visiting the ASTHO Profile Survey website.

The 2019 ASTHO Profile Survey is a survey conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The survey aims to define the scope of state and territorial public health services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The instrument was disseminated electronically in April 2019 and completed by state and territorial health agency staff at each S/THA including senior deputies, chief financial officers, and human resource directors. The survey closed in January 2020; the response rate was 100% percent among the 50 states and D.C., and 98% percent among all states, territories, and freely associated states.

Changes may be made to the dataset after it is archived. Please contact [email protected] to request the most updated datasets. Additional information on the study can be found by visiting the ASTHO Profile Survey website.

The 2020 ASTHO Profile Survey is a survey conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The survey aims to define the scope of state and territorial public health services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The instrument was significantly shortened for this data collection and separated into three separate surveys. The surveys were administered in December 2020 and completed by state and territorial health agency staff at each S/THA including senior deputies, chief financial officers, and human resource directors. The survey closed in March 2021; 80% of states and DC responded to at least one survey, of which 40% of states and DC responded to all three surveys; 38% of territories responded to at least one survey, of which 11% responded to all three surveys.

Changes may be made to the dataset after it is archived. Please contact [email protected] to request the most updated datasets. Additional information on the study can be found by visiting the ASTHO Profile Survey website.

The 2022 ASTHO Profile Survey is a survey conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The Profile aims to define the scope of S/THA services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The Profile began in 2007 and was fielded on average every three years between 2007 and 2022. The data collected through the Profile represent the breadth of work overseen by health agencies and shows how the public health field has shifted in response to societal changes and emergent needs. Data also reflect the structural nuances and limitations in which agencies conduct their work.

Changes may be made to the dataset after it is archived. Please contact [email protected] to request the most updated datasets. Additional information on the study can be found by visiting the ASTHO Profile Survey website.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs are part of a combined health and human services agency.

The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2014 dataset, and includes 133 variables for 648 cases, with demographic variables related to LHD budgets, governance type, and number of employees.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs are part of a combined health and human services agency.

The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2014 dataset, and includes 140 variables for 648 cases, with demographic variables related to LHD budgets, governance type, and number of employees.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' budgets, staff, and programs. The Forces of Change Survey continues to measure changes in Local Health Department (LHD) budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs were part of a combined health and human services agency.

The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2015 dataset, and includes 101 variables for 690 cases, with demographic variables related to LHD budgets.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' budgets, staff, and programs. The Forces of Change Survey continues to measure changes in Local Health Department (LHD) budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs were part of a combined health and human services agency.

The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2015 dataset, which includes 103 variables for 690 cases and demographic variables related to the size of population served and LHD budgets.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in local health departments, such as health reform and accreditation. This current iteration of the survey collected information about Zika response; local health departments involvement in multi-sectoral partnerships; and workforce recruitment.

The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2017 dataset, and includes 192 variables for 948 cases, with demographic variables related to LHD budgets.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. This current iteration of the survey collected information about Zika response; LHDs involvement in multi-sectoral partnerships; and workforce recruitment.

The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2017 dataset, and includes 195 variables for 948 cases, with demographic variables related to LHD budgets.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in local health departments, such as health reform and accreditation. The 2018 Forces of Change survey was distributed to a stratified random sample of 966 LHDs in the United States.

The survey included six topics: (1) Budget Cuts and Job Losses, (2) Response to Opioid Use and Abuse, (3) Population Health Activities, (4) Influenza Preparedness and Response, (5) Informatics Capacity, and (6) Environmental Health Activities.

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey was developed as an evolution to NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys), which measured the impact of the economic recession on local health departments' (LHDs) budgets, staff, and programs.

The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs. For the 2020 Forces of Change survey, the core set of questions were distributed to a total of 2392 LHDs in the United States, with a stratified random sample of 905 LHDs receiving the module questionnaire.

More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs are part of a combined health and human services agency.

The National Association of County and City Health Officials' (NACCHO's) Forces of Change Survey was developed as an evolution to NACCHO's Job Losses and Program Cuts surveys, which measured the impact of the economic recession on local health departments' (LHDs) budgets, staff, and programs.

Beginning in 2014, NACCHO began conducting the Forces of Change survey yearly in years that the National Profile Study of Local Health Departments (Profile) was not fielded. The Forces of Change Survey continues to measure changes in LHD budgets, staff, programs, and assess more broadly the impact of forces affecting change in LHDs.

More specifically, the survey collected information about staffing and budget changes, agency governance, engagement with fellowship/training programs, public health nursing activities, evaluation capacity, and services to address the infectious disease consequences of the opioid crisis.

This collection comprises a single data file which was produced as part of the data harmonization efforts of the Robert Wood Johnson Foundation and the United States Centers for Disease Control and Prevention. The file contains merged data from five sources:

1. 2010 National Profile of Local Health Departments, a survey of local health departments conducted by the National Association of County and City Health Officials (NACCHO).

2. 2011 National Profile Survey of Local Boards of Health, a survey of local boards of health conducted by the National Association of Local Boards of Health (NALBOH).

3. 2010 State and Territorial Public Health Survey, a survey of state and United States territory health departments conducted by the Association of State and Territorial Health Officials (ASTHO).

4. 2011 County Health Rankings, a compilation of county-level health measures and within-state county health rankings produced by the University of Wisconsin Population Health Institute.

5. 2010 Census Demographic Profile Summary File, a series of tables with housing and population data from the 2010 Census.

Produced by matching data from the last four sources to the NACCHO data, the data file contains one case for each of the 2,107 local health departments (LHD) that responded to the NACCHO survey. Each LHD's record in the file includes the ASTHO data for its state health department and the NALBOH data for its local board of health (LBH), if it had a LBH and the LBH responded to the NALBOH survey. (If a LHD had multiple LBHs, then the first one in the NALBOH data was matched to the LHD). In addition, county (or county equivalent)-level data from the County Health Rankings and Census Demographic Profile Summary File were matched to the records of the 1,535 LHDs represented in the data file with a jurisdiction covering a single county or county equivalent.

Conducted by the National Association of County and City Health Officials (NACCHO), the purpose of this survey of local health departments (LHDs) was to advance and support the development of a database for LHDs to describe and understand their structure, function, and capacities. A core set of questions was submitted to every LHD. In addition, some LHDs received one of two randomly assigned modules of supplemental questions.

Data from the National Profile of Local Health Departments survey are used by:

1. LHD staff members to compare their LHD or those within their states to others nationwide;
2. Policymakers at the local, state, and federal levels to inform public health policy and support projects to improve local public health practice;
3. Universities to educate future public health workforce members about LHDs;
4. Researchers to address questions about public health practice; and
5. NACCHO staff to develop programs and resources that meet the needs of LHDs and to advocate effectively for LHDs.

Data included as part of this collection includes the Public-Use (Restricted-Use Level 1) data of the National Profile of Local Health Departments 2016 study. The dataset includes 1930 cases for 1112 variables.

Conducted by the National Association of County and City Health Officials (NACCHO), the purpose of this survey of local health departments (LHDs) was to advance and support the development of a database for LHDs to describe and understand their structure, function, and capacities. A core set of questions was submitted to every LHD. In addition, some LHDs received one of two randomly assigned modules of supplemental questions.

Data from the National Profile of Local Health Departments survey are used by:

1. LHD staff members to compare their LHD or those within their states to others nationwide;
2. Policymakers at the local, state, and federal levels to inform public health policy and support projects to improve local public health practice;
3. Universities to educate future public health workforce members about LHDs;
4. Researchers to address questions about public health practice; and
5. NACCHO staff to develop programs and resources that meet the needs of LHDs and to advocate effectively for LHDs.

Data included as part of this collection includes the Restricted-Use (Restricted-Use Level 2) data of the National Profile of Local Health Departments 2016 study. The dataset includes 1930 cases for 1116 variables.

These data were collected as part of an assessment of in-person and webinar AFIX consultations on best practices for adolescent HPV immunization. AFIX (which stands for Assessment, Feedback, Incentives, and eXchange) is a program of the Center for Disease Control and Prevention aimed at increasing vaccination of children and adolescents by reducing missed opportunities to vaccinate and improving immunization delivery practices at the provider level.

High-volume primary care clinics serving over 370,000 patients ages 11-17 in three states were randomly assigned to receive no consultation or an in-person or webinar AFIX consultation focused on improving adolescent HPV immunization. Immunization specialists from participating state health departments delivered the consultations. Physicians, nurses and other clinic staff in the in-person and webinar arms who participated in the consultation sessions completed web-based surveys pre-consultation (pre-visit survey), post-consultation (post-visit survey) and at six-month follow up (follow-up survey). Topics covered by the surveys include participation in and satisfaction with the assigned consultation delivery mode; strategies for improving HPV vaccination coverage used by the respondents' clinics; opinions about the level of HPV vaccination coverage in the respondents' clinics; and the respondents' self-efficacy for improving HPV vaccination coverage.