Spending patterns of middle schools that deliver multiple evidence-based physical activity and nutrition programs.

Physical activity and nutrition programs improve children's health. However, cost and competition for resources between programs are common implementation challenges. Currently, no guidance exists for practitioners about how to spend money within various programs. This study examines spending patterns of schools that concurrently delivered multiple programs to help provide spending guidance. Middle schools (n = 8; 75% rural) that participated in the Healthy School Recognized Campus (HSRC) initiative were provided $3500. To achieve HSRC recognition, schools complete a school-wide walking program, a physical activity or nutrition program for students, and a physical activity or nutrition program for adults (teachers and parents). We tracked purchases, grouped receipts by categories and program, and analyzed spending using descriptive statistics. On average, schools spent $3383.26 ± $159.27. For both adult and teacher incentives, over half of the schools spent $0. Program equipment ($1145.14 ± $1139.10; e.g. cooking equipment and hydroponics kit) was the largest category of spending, followed by student incentives ($945.04 ± $946.62). Schools purchased 5031 items (628.88 ± 926.50 items/school) categorized as small student incentives (e.g. water bottles and gift cards), averaging $1.04 each, and 12 items (1.5 ± 2.78 items/school) on large student incentives (e.g. bike) averaging $124.72 each. On average schools completed 2.88 ± 0.83 (range 2-4) youth programs and 1.50 ± 0.93 (range 0-2) adult programs, which cost around $300-$1500 and $0-$700 per program, respectively. Schools spent almost all the money allocated for HSRC and made strategic spending decisions to maximize student engagement, specifically prioritizing student programs over adult ones. This information about how schools spend their money offers insights for decision-making in future programs.