Date of Award


Level of Access

Campus-Only Thesis

Degree Name

Master of Science (MS)


Food Science and Human Nutrition


Mary Ellen Camire

Second Committee Member

Mario Teisl

Third Committee Member

Kathryn Yerxa


Introduction: Populations of limited income and limited education generally exhibit higher rates of diet-related health problems and often have limited access to, and support for, making optimal nutrition and lifestyle choices. In Maine, the Eat Well Nutrition Education Program addresses these disparities by increasing capacity for healthful food choices among low-income individuals and families, with the long-term goal of reducing diet-related disease. Impact evaluations for nutrition education programs tend to focus most often on the behavioral and health changes of their participants; however, due to increasingly constrained public budgets and ever increasing health care costs, there is a growing demand for programs to illustrate the net economic returns in public health investments to secure continued support.

Objective: To use benefit-cost and cost-effectiveness analyses to evaluate the Eat Well Nutrition Education Program’s impact on disease prevention.

Methods: Retrospective cost-effectiveness and cost-benefit studies were conducted using demographic, food/nutrient intake, and food-related behavioral data collected by Nutrition Associates throughout the state. Participants included 989 adults who had graduated from Eat Well in fiscal year 2011 (FY11). Cost-effectiveness ratios were determined using behavior change data and health-utility scores. Benefit-cost ratios were estimated from costs and monetized benefits.

Results: The cost to society per program graduate was determined to be $1,071.86. Total health benefits gained through participation in the Eat Well Program, as measured in Quality Adjusted Life Years (QALYs), was 5.629 QALYs saved, at a cost of $221,136.44 per QALY (sensitivity 3.212 - 8.945 QALY, at $139,158.97 - $387,539.42). Standard cost-benefit analysis resulted in a $0.10 return for every $1.00 invested in the program, and a societal approach yielded a $0.77 return. The cost per program impact, as measured in improved nutrition behavior, was determined to be $878.51.

Conclusions: Benefit-cost ratios of greater than one and a cost-per-QALY of less than $50,000 are standard cutoffs for determining a program’s cost-benefit and cost- effectiveness, respectively. Given these guidelines, the Eat Well Program did not demonstrate high economic impact for FY11.