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  1. Menachemi, Nir PhD, MPH
  2. Danielson, Elizabeth C. MA
  3. Tilson, Hugh A. MD, DrPH
  4. Yeager, Valerie A. DrPH
  5. Sellers, Katie DrPH, CPH
  6. Halverson, Paul K. DrPH, FACHE
  7. for the SHO-CASE Steering Committee


Objective: To examine characteristics associated with tenure length of State Health Officials (SHOs) and examine reasons and consequences for SHO turnover.


Design: Surveys of current and former SHOs linked with secondary data from the United Health Foundation.


Setting: Original survey responses from SHOs in the United States.


Participants: Respondents included SHOs who served between 1973 and 2017.


Main Outcome Measures: Tenure length and consequences of SHO turnover.


Results: Average completed tenure among SHOs was 5.3 years (median = 4) and was shorter in recent time periods compared with decades prior. Older age at appointment ([beta] = -0.109, P = .005) and those holding a management degree ([beta] = -1.835, P = .017) and/or a law degree ([beta] = -3.553, P < .001) were each associated with shorter SHO tenures. State Health Officials from states in the top quartile for health rankings had significantly longer average tenures ([beta] = 1.717, P = .036). Many former SHOs believed that their tenure was too short and reported that their departure had either a significant or very large effect on their agency's ability to fulfill its mission.


Conclusions: State Health Official tenures have become shorter over time and continue to be shorter than industry chief executive officers and best practice recommendations from organizational researchers. States have an opportunity to consider and address how factors within their control influence the stability of the SHO position.