DOI: 10.3886/icpsr37103
title: Forces of Change Survey, United States, 2017, Restricted-Use Level 1 Data
title: Archival Version

description: 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.
description: 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' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes LHD budgets, staff, and programs and assesses more broadly the impact of forces affecting change in LHDs (such as health reform). Beginning in 2014, NACCHO began conducting the Forces of Change survey yearly in years that the National Profile Study of Local Health Departments was not fielded.
description: NACCHO administered the questionnaire using Qualtrics, an online survey administration tool. On February 14, 2017, the designated primary contact of every local health department (LHD) in the sample received an invitation via email from NACCHO's president to participate in the survey. After the initial invitation, the potential participants received up to five reminder e-mails. Additionally, NACCHO made reminder calls to people who had yet to complete the survey, targeting states with low response rates. Some state associations of county and city health officials (SACCHOs) assisted by encouraging their members to take part in the survey. 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.
description: The Forces of Change Survey instrument included some questions used in previous surveys conducted by NACCHO (including the 2015 Forces of Change survey, Job Losses and Program Cuts surveys, and the National Profile of Local Health Departments). Variables are related to questionnaire topics, including budget cuts and job losses, role in Zika prevention and response, and local health departments' collaboration with healthcare.
description: A weight variable (SWEIGHT_C0FOCSTRATUM) has been included and must be used in any analysis.
description: Response Rates: 65%
description: NACCHO used a stratified random sampling design for the 2017 Forces of Change Survey. A representative sample was used instead of a complete census design to minimize survey burden on local health departments (LHD) while enabling the calculation of both national-and state-level estimates. LHDs were stratified by two variables: size of the population served and state. For stratification by size of population served, three categories were used: small (less than 50,000 people served), medium (50,000-499,999 people served), and large (more than 500,000 people served). Because LHDs with large population sizes represent a relatively small portion of all LHDs, these LHDs were oversampled to ensure a sufficient number of responses for the analysis. Two states (Hawaii and Rhode Island) were excluded from the study because they had no LHDs. Additionally some states did not have any LHDs in a particular size category, resulting in a total of 122 strata. The sampling plan was designed to select a minimum of 33 percent of the LHDs in a given stratum and at least two LHDs per stratum whenever possible. Once the sampling plan was finalized, NACCHO drew a random sample of the specified size from within each stratum. In some centralized states, two or more LHDs had the same primary contact person listed. To minimize response burden, no more than two LHDs with the same contact person were kept in the sample. However, contacts in Alabama, Oklahoma, and Vermont received three surveys each because additional contacts in their state were not available. When LHDs with a common contact person were dropped from sample or when contact information was not available, a replacement was drawn. Overall, a sample of 948 LHDs was selected, of which 615 responded.
description: Datasets: DS1: Public-Use Dataset
description: Local health departments (LHD) in 48 states and the District of Columbia. Hawaii and Rhode Island were excluded from the survey because they had no local health departments.
description: web-based surveyAdditional information about this study is available on the Forces of Change website.The restricted-use data (Restricted-Use Level 2) associated with the Forces of Change 2017 Study is available as ICPSR 37141.Additional Forces of Change studies related to this collection are available as ICPSR 37069 (2015 Restricted-Use Level 1), ICPSR 37140 (2015 Restricted-Use Level 2), ICPSR 36153 (2014 Restricted-Use Level 1), and ICPSR 37139 (2014 Restricted-Use Level 2).