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Healthy vending machine options

Health Factors: Diet & Exercise
Decision Makers: Educators Employers & Businesses Local Government State Government Healthcare Professionals & Advocates Nonprofit Leaders
Evidence Rating: Some Evidence
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

There are a variety of mechanisms to increase healthy options in vending machines, including reducing the price of healthy choices and increasing the number of healthy choices compared to unhealthy choices. 

Expected Beneficial Outcomes

Improved dietary choices
Increased healthy food consumption
Improved nutrition

Evidence of Effectiveness

There is some evidence that increasing healthy options in vending machines improves dietary behaviors (Story 2008, Cradock 2011, French 2001), especially when healthy options are made relatively less expensive than unhealthy options (French 2010). Price discounts for healthier foods have been shown to increase consumption of healthier foods (An 2013, Story 2008, AHA-Mozaffarian 2012). Vending machine nutrition standards and increased healthy vending options are suggested strategies to improve nutrition (IOM-Government obesity prevention 2009, CDC-Make a differenceCDC-Fruits and vegetables 2011, Wiecha 2006, Briefel 2009, Kubik 2003, Alaimo 2013). Additional evidence, especially studies focused solely on vending machines, is needed to confirm effects. 

Restricting the sale of sugar sweetened beverages has been shown to reduce consumption among high school students (Cradock 2011) and kindergartners (Fernandes 2008). Young people suggest that increasing healthy options in vending machines may facilitate improvements in their eating (EPPI-Shepherd 2001).

Competitive food availability through vending machines, snack bars, or à la carte, is not associated with adolescent weight gain in one study of 5th to 8th graders (Van Hook 2012), suggesting that systemic changes to the broader food environment may be needed to substantially reduce weight gain. States with strong laws governing competitive food nutrition content across grade levels, including vending machine food choices, appear to reduce adolescent body mass index (BMI) increases and the likelihood of adolescents remaining overweight (Taber 2012).

Vending machines generate significant revenue, particularly for schools. Some studies show no net fiscal effect from changing vending machine policies in schools and workplaces (Wharton 2008, Fiske 2004, Kocken 2012), and possibly, a positive fiscal impact (Fox 2005a, Lessard 2014). Other studies find data on revenue impacts too limited to adequately determine how changes in food options will affect school revenue (US GAO-Bellis 2005).

One study suggests that vending machines offering healthy options are also feasible in hospital settings (Van Hulst 2013).

Implementation

United States

As of 2008, vending machines were available in 17%, 82%, and 97% of elementary, middle, and high schools respectively (Finkelstein 2008). State initiatives supporting healthy vending machines are in Rhode Island (CDC-Rhode Island), Hawaii (HI SDH-CHN), Alabama, Iowa, Mississippi, and Ohio (CDC-HVMI). Many localities also have healthy vending machine standards in their schools and public county buildings, for example, Chicago, IL (Suarez-Balcazar 2007), Cameron County, TX; King County, WA; and several counties in California (CDC-HVMI). A study of Chicago Public Schools illustrates some challenges and successes from efforts to improve vending machine options (Suarez-Balcazar 2007).

Wisconsin

A number of Wisconsin school districts have implemented vending machine standards or replaced soda vending machines with milk vending machines (WI DPI-Camber Davidson 2008).

Implementation Resources

CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities. Accessed on March 7, 2016
ChangeLab-Healthy vending - ChangeLab Solutions. Healthy vending machines. Accessed on December 14, 2015
HOST-Healthy eating - Healthy Out-of-School Time (HOST) Coalition. Resources: Healthy eating. Accessed on March 7, 2016
LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014. Accessed on March 1, 2016
USDA-FNS wellness - US Department of Agriculture (USDA), Food and Nutrition Service (FNS). Local school wellness policy. Accessed on February 7, 2017
WI DPI-School wellness - Wisconsin Department of Public Instruction (DPI). School wellness policy. Accessed on December 12, 2015
YES!-Toolkits - Youth Empowered Solutions (YES!). Toolkits and resources. Accessed on April 12, 2017

Citations - Evidence

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63. Accessed on February 6, 2017
Alaimo 2013* - Alaimo K, Oleksyk SC, Drzal NB, et al. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children’s diets. Childhood obesity. 2013;9(6):509-523. Accessed on March 7, 2016
An 2013* - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-28. Accessed on March 1, 2016
Briefel 2009* - Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of US public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S91-107. Accessed on April 26, 2017
CDC-Fruits and vegetables 2011 - Centers for Disease Control and Prevention (CDC). Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to increase the consumption of fruits and vegetables. Atlanta: US Department of Health and Human Services (US DHHS); 2011. Accessed on March 1, 2017
CDC-Make a difference - Centers for Disease Control and Prevention (CDC). Make a difference at your school! CDC resources can help you implement strategies to prevent obesity among children and adolescents. Atlanta: Centers for Disease Control and Prevention (CDC); 2008. Accessed on December 7, 2015
Cradock 2011 - Cradock AL, McHugh A, Mont-Ferguson H, et al. Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006. Preventing Chronic Disease. 2011;8(4):A74. Accessed on December 8, 2015
EPPI-Shepherd 2001 - Shepherd J, Harden A, Rees R, et al. Young people and healthy eating: A systematic review of research on barriers and facilitators. London, UK: Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit (SSRU), Institute of Education, University of London; 2001. Accessed on January 20, 2016
Fernandes 2008* - Fernandes MM. The effect of soft drink availability in elementary schools on consumption. Journal of the American Dietetic Association. 2008;108(9):1445-52. Accessed on February 5, 2016
Fiske 2004* - Fiske A, Cullen KW. Effects of promotional materials on vending sales of low-fat items in teachers’ lounges. Journal of the American Dietetic Association. 2004;104(1):90-3. Accessed on February 5, 2016
Fox 2005a - Fox S, Meinen A, Pesik M, Landis M, Remington PL. Competitive food initiatives in schools and overweight in children: A review of the evidence. Wisconsin Medical Journal. 2005;104(5):38-43. Accessed on February 5, 2016
French 2001* - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309–35. Accessed on February 2, 2017
French 2010 - French SA, Hannan PJ, Harnack LJ, et al. Pricing and availability intervention in vending machines at four bus garages. Journal of Occupational and Environmental Medicine. 2010;52(Suppl 1):S29-33. Accessed on February 5, 2016
IOM-Government obesity prevention 2009* - Institute of Medicine (IOM), National Research Council (NRC), Committee on Childhood Obesity Prevention Actions for Local Governments. Local government actions to prevent childhood obesity. (Parker L, Burns AC, Sanchez E, eds.). Washington, DC: National Academies Press; 2009. Accessed on February 17, 2016
Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. Journal of School Health. 2012;82(3):115–22. Accessed on March 3, 2016
Kubik 2003 - Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M. The association of the school food environment with dietary behaviors of young adolescents. American Journal of Public Health. 2003;93(7):1168-73. Accessed on February 17, 2016
Lessard 2014 - Lessard L, Poland M, Trotter M. Lessons learned from a healthful vending pilot program in Delaware state agency buildings, 2011-2012. Preventing Chronic Disease. 2014;11(140188):1-8. Accessed on March 7, 2016
Story 2008* - Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health. 2008;29:253-72. Accessed on November 9, 2015
Taber 2012 - Taber DR, Chriqui JF, Perna FM, Powell LM, Chaloupka FJ. Weight status among adolescents in States that govern competitive food nutrition content. Pediatrics. 2012;130(3):437–44. Accessed on May 24, 2016
US GAO-Bellis 2005 - Bellis D. School meal programs: Competitive foods are widely available and generate substantial revenues for schools. Washington, DC: US Government Accountability Office (US GAO);2005: GAO-05-563. Accessed on February 27, 2017
Van Hook 2012 - Van Hook J, Altman CE. Competitive food sales in schools and childhood obesity: A longitudinal study. Sociology of Education. 2012;85(1):23–39. Accessed on May 24, 2016
Van Hulst 2013* - Van Hulst A, Barnett TA, Dervy V, Cote G, Colin C. Health-promoting vending machines: Evaluation of a pediatric hospital intervention. Canadian Journal of Dietetic Practice and Research. 2013;74(1):28-34. Accessed on November 10, 2015
Wharton 2008* - Wharton CM, Long M, Schwartz MB. Changing nutrition standards in schools: The emerging impact on school revenue. Journal of School Health. 2008;78(5):245-51. Accessed on November 9, 2015
Wiecha 2006* - Wiecha JL, Finkelstein D, Troped PJ, Fragala M, Peterson KE. School vending machine use and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth. Journal of the American Dietetic Association. 2006;106(10):1624-30. Accessed on November 9, 2015

Citations - Implementation

CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities. Accessed on March 7, 2016
CDC-Rhode Island - Centers for Disease Control and Prevention (CDC). Healthy vending in Rhode Island public school districts. Accessed on March 7, 2016
Finkelstein 2008 - Finkelstein DM, Hill EL, Whitaker RC. School food environments and policies in US public schools. Pediatrics. 2008;122(1):e251-9. Accessed on February 5, 2016
HI SDH-CHN - Hawaii State Department of Health (HI SDH). Choose healthy now (CHN) healthy vending project. Accessed on March 7, 2016
Suarez-Balcazar 2007 - Suarez-Balcazar Y, Redmond L, Kouba J, et al. Introducing systems change in the schools: The case of school luncheons and vending machines. American Journal of Community Psychology. 2007;39(3-4):335-45. Accessed on November 9, 2015
WI DPI-Camber Davidson 2008 - Camber Davidson J. What’s right for kids 2: Building a healthy school nutrition environment. Madison: Department of Public Instruction (DPI); 2008. Accessed on April 6, 2016

Page Last Updated

October 21, 2015

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