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The Americans' Changing Lives (ACL) survey series is an ongoing, nationally representative, longitudinal study focusing especially on differences between Black and White Americans in middle and late life. These data constitute the first, second, third, fourth, fifth, and sixth waves in a panel survey covering a wide range of sociological, psychological, mental, and physical health items. Wave I of the study began in 1986 with a nation face-to-face survey of 3,617 adults ages 25 and up, with Black Americans and people aged 60 and over over-sampled at twice the rate of the others. Wave II constitutes face-to-face re-interviews in 1989 of those still alive. Survivors have been re-interviewed by telephone, and when necessary face-to-face, in 1994 (Wave III), 2001/02 (Wave IV), 2011 (Wave V), and 2019/21 (Wave VI).

Please note that for Wave VI, the majority of data collection occurred in 2019, with only a small subset (n=39) of participants surveyed in 2021.

ACL was designed and sought to investigate the following: (1) The ways in which a wide range of activities and social relationships that people engage in are broadly "productive," (2) how individuals adapt to acute life events and chronic stresses that threaten the maintenance of health, effective functioning, and productive activity, and (3) sociocultural variations in the nature, meaning, determinants, and consequences of productive activity and relationships. Among the topics covered are interpersonal relationships (spouse/partner, children, parents, friends), sources and levels of satisfaction, social interactions and leisure activities, traumatic life events (physical assault, serious illness, divorce, death of a loved one, financial or legal problems), perceptions of retirement, health behaviors (smoking, alcohol consumption, overweight, rest), and utilization of health care services (doctor visits, hospitalization, nursing home institutionalization, bed days). Also included are measures of physical health, psychological well-being, and indices referring to cognitive functioning.

Demographic information provided for individuals includes household composition, number of children and grandchildren, employment status, occupation and work history, income, family financial situation, religious beliefs and practices, ethnicity, race, education, sex, and region of residence.

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 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.

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 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 2018 RWJF National Survey of Health Attitudes. This 2018 survey is considered the second wave, the first wave of the survey was conducted in 2015 (ICPSR 37405). In 2018, the study team fielded an updated version that included many of the same questions but added some new constructs that were of interest as part of the larger Culture of Health effort. This study 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).

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.