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Rural American youth exhibit pronounced health disparities. This study enlists insights from an economy of scale paradigm to determine the relative effects of serving smaller versus larger client groups in an assembly-style school-based behavioral health promotion program. Evaluation results are reported from a three-year intervention delivered to eighth-grade and tenth-grade rural Mississippi students from 2012 to 2015. The program, I Got U: Healthy Life Choices for Teens, coupled a day-long intensive immersion in youth risk prevention and mental health promotion with school-based information dissemination. Results reveal robust effectiveness in program years 1 and 2, during which caps of 175 attendees per event were imposed. Salutary results were no longer evident during year 3, when larger venues were used to serve over three times the number of students per event. This program teaches valuable lessons about the potential for diminishing returns yielded by an economy of scale approach to implementation.

Good Things in Small Packages? Evaluating an Economy of Scale Approach to Behavioral Health Promotion in Rural America