Forces of Change Survey, United States, 2020 (ICPSR 39356)

Version Date: Apr 7, 2026

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

Series:

https://doi.org/10.3886/ICPSR39356.v1

Version V1

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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.

Citation

National Association of County and City Health Officials. Forces of Change Survey, United States, 2020. Inter-university Consortium for Political and Social Research [distributor], 2026-04-07. https://doi.org/10.3886/ICPSR39356.v1

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Funding

Robert Wood Johnson Foundation (78802), United States Department of Health and Human Services. Centers for Disease Control and Prevention (NU38OT000306-04-00)

Subject Terms

Geographic Coverage

Smallest Geographic Unit

State

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.

Distributor(s)

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

2020

Date of Collection

2020-10-07 -- 2021-02-26

Data Collection Notes

  1. Additional information about this study is available on the Forces of Change website.
  2. 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).
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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

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

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

Cross-sectional

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

Organization

Data Type(s)

Mode of Data Collection

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

Response rate of approximately 24% for the core questionnaire and 26% for the module.

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Original Release Date

2026-04-07

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.

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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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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.

  • ICPSR usually offers files in multiple formats for researchers to be able to access data and documentation in formats that work well within their needs. If you have questions about the accessibility of materials distributed by ICPSR or require further assistance, please visit ICPSR’s Accessibility Center.

  • 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.

HMCA logo

This study is maintained and distributed by the Health and Medical Care Archive (HMCA). HMCA is the official data archive of the Robert Wood Johnson Foundation.