Forces of Change Survey, United States, 2020 (ICPSR 39356)
Version Date: Apr 7, 2026 View help for published
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National Association of County and City Health Officials
Series:
https://doi.org/10.3886/ICPSR39356.v1
Version V1
Summary View help for Summary
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.
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Geographic Coverage View help for Geographic Coverage
Smallest Geographic Unit View help for Smallest Geographic Unit
State
Restrictions View help for Restrictions
Access to the Restricted-Use Dataset is restricted. Users interested in obtaining these data must complete a Restricted Data Use Agreement and specify the reason for the request.
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Data Collection Notes View help for Data Collection Notes
- Additional information about this study is available on the Forces of Change website.
- Additional Forces of Change studies related to this collection are available as ICPSR 38307 (2018 Restricted-Use and Public-Use), ICPSR 37103 (2017 Restricted-Use Level 1), and ICPSR 37141 (2017 Restricted-Use Level 2).
Study Purpose View help for Study Purpose
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 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. 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.
Study Design View help for Study Design
NACCHO administered the questionnaire using Qualtrics, an online survey administration tool. On October 7, 2020, the designated primary contact of every LHD in the sample received an invitation via email to participate in the survey.
NACCHO staff and a nationwide group of Forces of Change study advocates conducted follow-up with non-respondents using e-mail messages and telephone calls. NACCHO also offered technical support to survey respondents through an e-mail address and telephone hotline. The survey was closed on February 26, 2021, with a response rate of approximately 24% for the core questionnaire and 26% for the module.
Sample View help for Sample
NACCHO used a stratified random sampling design for the 2020 Forces of Change Survey. A representative sample was used instead of a complete census design to minimize survey burden on LHDs while enabling the calculation of both national-and state-level estimates.
For the 2020 Forces of Change survey, a total of 2392 LHDs were included in the study population. Rhode Island was excluded from the study because the state has no sub-state public health units.
All LHDs in the study population received a common core set of questions. In addition to the core questionnaire sent to the full population, a stratified random sample of 905 LHDs were invited to complete a module questionnaire. Strata for the sampling strategy were defined by the state and the size of the population served. Post-stratification (based on 7 population size categories - c0popcat7) and finite population correction were used to adjust for item non-response and to account for the fact that population size by category is known and limited in size. The number of LHDs in the study population within each stratum for c0popcat7 is reflected in core_denom variable.
Time Method View help for Time Method
Universe View help for Universe
Local health departments (LHD) 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 View help for Unit(s) of Observation
Data Type(s) View help for Data Type(s)
Mode of Data Collection View help for Mode of Data Collection
Description of Variables View help for Description of Variables
The 2020 Forces of Change Survey measures changes in LHD budgets, staff, and programs and assesses more broadly the impact of forces, specifically COVID-19, affecting change in LHDs.
Response Rates View help for Response Rates
Response rate of approximately 24% for the core questionnaire and 26% for the module.
HideOriginal Release Date View help for Original Release Date
2026-04-07
Version History View help for Version History
2026-04-07 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:
- Created online analysis version with question text.
- Checked for undocumented or out-of-range codes.
Weight View help for Weight
This study utilized post-stratification weighting. More information can be found in the "Survey Weights and National Estimates" section of the P.I. Codebook.
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