Forces of Change Survey, United States, 2023 (ICPSR 39352)

Version Date: Aug 20, 2025

Cite this study |

Principal Investigator(s):
National Association of County and City Health Officials

Series:

https://doi.org/10.3886/ICPSR39352.v1

Version V1

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Summary

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.

Citation

National Association of County and City Health Officials. Forces of Change Survey, United States, 2023. Inter-university Consortium for Political and Social Research [distributor], 2025-08-20. https://doi.org/10.3886/ICPSR39352.v1

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Funding

Robert Wood Johnson Foundation (78802)

Subject Terms

Geographic Coverage

Smallest Geographic Unit

State

Restrictions

Access to these data is restricted. Users interested in obtaining these data must complete a Restricted Data Use Agreement and specify the reason for the request.

Distributor(s)

Inter-university Consortium for Political and Social Research
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Time Period(s)

2023

Date of Collection

2023-03-31 -- 2023-06-15

Data Collection Notes

  1. Additional information about this study is available on the Forces of Change website.
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Study Purpose

For the 2023 Forces of Change Survey, NACCHO surveyed LHDs to measure changes in budgets, staff, programs, and assess more broadly the impact of forces affecting change in LHDs.

Study Design

NACCHO administered the questionnaire using Qualtrics, an online survey administration tool. On March 31, 2023, the designated primary contact of every local health department (LHD) in the sample received an invitation via email to participate in the survey. After the initial invitation, NACCHO staff and Forces of Change study advocates conducted follow-up with non-respondents using email messages and telephone calls.

NACCHO generated national statistics using estimation weights to account for sampling and non-response. All data were self-reported; NACCHO did not independently verify the data provided by LHDs. A detailed description of survey methodology is available on NACCHO's Forces of Change webpage.

Sample

The 2023 Forces of Change study used a stratified random sampling design. NACCHO randomly sampled 1,200 LHDs, stratified by size of population served. The population served measure had 7 population categories: LHDs serving less than 25,000 people, 25,000-49,999 people, 50,000-99,999 people, 100,000-249,999 people, 250,000-499,999 people, 500,000-999,999 people and more than 1,000,000 people served. A representative sample was used instead of a complete census design to minimize survey burden on LHDs while enabling the calculation of national-level estimates.

Time Method

Cross-sectional

Universe

Local health departments (LHDs) in the United States. Rhode Island was excluded from the study because the state has no sub-state public health units.

Unit(s) of Observation

Organization

Data Type(s)

Mode of Data Collection

Response Rates

532 LHDs completed the survey for a response rate of 44%.

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Original Release Date

2025-08-20

Version History

2025-08-20 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

  • Performed consistency checks.
  • Created online analysis version with question text.
  • Checked for undocumented or out-of-range codes.

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Weight

Weights are not directly provided in the dataset, however instructions to generate weights can be found in the P.I. Codebook under the heading "Survey Weights and National Estimates".

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Notes

  • The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.

  • One or more files in this data collection have special restrictions. Restricted data files are not available for direct download from the website; click on the Restricted Data button to learn more.

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