title: Cost and Cost-Effectiveness of Students for Nutrition and eXercise (SNaX).
abstract: OBJECTIVE
  To examine the cost and cost-effectiveness of implementing Students for Nutrition and eXercise (SNaX), a 5-week middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education.
  
  
  METHODS
  Five intervention and 5 control middle schools (mean enrollment, 1520 students) from the Los Angeles Unified School District participated in a randomized controlled trial of SNaX. Acquisition costs for materials and time and wage data for employees involved in implementing the program were used to estimate fixed and variable costs. Cost-effectiveness was determined using the ratio of variable costs to program efficacy outcomes.
  
  
  RESULTS
  The costs of implementing the program over 5 weeks were $5433.26 per school in fixed costs and $2.11 per student in variable costs, equaling a total cost of $8637.17 per school, or $0.23 per student per day. This investment yielded significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks. The cost-effectiveness of the program, per student over 5 weeks, was $1.20 per additional fruit served during meals, $8.43 per additional full-priced lunch served, $2.11 per additional reduced-price/free lunch served, and $1.69 per reduction in snacks sold.
  
  
  CONCLUSIONS
  SNaX demonstrated the feasibility and cost-effectiveness of a middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Its cost is modest and unlikely to be a significant barrier to adoption for many schools considering its implementation.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, NY; Department of Population Health, New York University School of Medicine, New York, NY. Electronic address: joseph.ladapo@nyumc.org.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ladapo
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; RAND Corporation, Santa Monica, Calif.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bogart
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; RAND Corporation, Santa Monica, Calif.
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
authors.affiliation: Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, Calif.
authors.forename: Burton O
authors.initials: BO
authors.lastname: Cowgill
authors.affiliation: Student Medical Services, Los Angeles Unified School District, Los Angeles, Calif.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Uyeda
authors.affiliation: Food Services Branch, Los Angeles Unified School District, Los Angeles, Calif.
authors.forename: David G
authors.initials: DG
authors.lastname: Binkle
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Stevens
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D002648:Child; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D000072001:Diet, Healthy; D015444:Exercise; D005240:Feasibility Studies; D005522:Food Services / Q000191:economics*; D006266:Health Education / Q000191:economics*; D006293:Health Promotion; D006801:Humans; D009765:Obesity / Q000517:prevention & control*; D010379:Peer Group; D012572:School Health Services / Q000191:economics*; D013334:Students
keywords: adolescents; cost; cost-effectiveness; fruits; health promotion; nutrition; schools; vegetables