Professional Documents
Culture Documents
Department of Nutrition
DEVELOPED MARCH
2009
TABLE OF CONTENTS
INTRODUCTION
10
APPENDICES
* Smart Snack: Healthy Vending System
* Example of Cling form Sticker
* Logic Model for Healthy Vending
* 5 Key Elements for Successful Vending Policy
* Manager Assessment Survey
* Employee Assessment Survey
* Survey of Worksite Vending Machines
* Sample Letters for Vendors
* Guidelines for Healthy Vending
13
REFERENCES
29
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INTRODUCTION
Our nation as a whole is battling the overweight and obesity epidemic that is
affecting both adults and children (1). In an effort to address this problem,
many strategies have been proposed by national, state, and local health
organizations (2, 3). One of these strategies involves building healthier
workplaces (2, 3). Since vending machines are part of the worksite eating
environment, making changes to increase the availability of healthier foods
for employees is important.
Therefore, in this Healthy Vending Toolkit, you will find existing literature on
environmental changes to vending machines at worksites and schools that has
shown the effectiveness of promoting a healthy eating environment.
Additional information on strategies that could be used in the worksite as well
as assessment tools will be provided to help guide wellness managers and
interested parties in their efforts to build a healthy environment.
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individuals working there to make more healthy food choices. For example,
vending machines at worksites can provide healthier food choices for
individuals. However, it is important to note that when healthy foods (fruits,
vegetables, low calorie, low fat snacks and/or beverages) are made available
in conjunction with less healthy foods (high-calorie, high- fat snacks,
beverages), healthful food choices may be compromised (4). Thus, many
researchers have turned to studying changing food availability in vending
machines at worksites and the effect on the food choices of individuals who
work in these environments.
A systematic review of the literature by Seymour et al (2) on the impact of
environmental interventions on point of purchase behavior in adults found
providing health information at the time of purchase influenced food choices.
The authors suggested that this action influences behavior change and that a
larger impact on healthy eating could be achieved by limiting the entire menu
to healthy choices, thus creating an environment in which individuals would
not have to actively choose healthier foods. This would be considered an
environmental change (2). Moreover, Fiske and colleagues (12) also found
increasing the availability of low-fat items along with promotional materials
in vending machines located in teachers lounges in elementary and middle
schools increased consumption of these food items. Another study found that
lowering the prices on healthier items, as compared to less healthful items,
increases their consumption (13).
Similar to the national trend in overweight and obesity, Knox County also
experienced a jump in reports of overweight and obesity from 2006 to 2007
from 58.3% to 67.4% (4). It is clear that interventions addressing the rising
trend of overweight and obesity need to be addressed. One environmental
change that can have an impact on a smaller scale and has shown to be
effective in research is implementing health vending in the worksite setting.
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Population:
Objective(s):
Methods:
Findings:
2.
Population:
Adult populations
Objective(s):
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Findings:
3.
Population:
Objective(s):
Methods:
Findings:
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4.
Populations:
Adults/schools/Teachers
Objective(s):
Methods:
Findings:
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Rationale
2g or less of Saturated
Fat
30g or less of sugar
Nuts and seeds are
exempt
100% juice are exempt
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II. ASSESSMENT
Step 5: In order to develop and implement your Healthy Vending Policy
successfully, the following must be assessed
A. The current status of vending machines at your worksite
B. The opinion, perceptions, and receptivity of worksite staff/employees
and/or vending machine users to healthy vending.
The assessments will help you determine exactly where the change could be
made and to what extent at your worksite. Use the assessment tools listed to
assess the stage of change of your worksite and where healthful changes could
be make. Realistic and achievable goals can be generated to help meet the
health needs of your worksite (17).
1.
2.
4.
3.
This is another way of getting the word out that that your worksite is trying to
make a change. Maybe through a newsletter, your worksite could have a
paragraph on how the company is looking to promote a healthy work
environment and would like to get the employee opinions on this matter.
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III. IMPLEMENTATION
Step 6: Communication is the key in ensuring the successful implementation of
your vending policy. Regular communication with the vendors can help ensure
that your worksite vending machines are being stocked with the foods
requested. Communication with vending machine users at the worksite can be a
means of outreach and education by encouraging the selection of healthy foods
(15).
A. Vendors:
- Use the letters in Appendices I and J to inform vendors of your plans or the
changes you would like to make to the foods available in your vending
machines.
- In addition, see the list of healthier food options in Appendix K that could
be provided to your vendor.
- Ask vendors to place less healthy foods towards the bottom of the
vending machines and make healthier foods more visible or towards the
top of the vending machines.
- Ask vendors to make healthier foods cheaper than less healthy foods.
B. Vending Machine Users:
- In addition, on-site promotion of health could be incorporated through
newsletters and education.
- Using a cling form sticker on each vending machine will help communicate
and promote the goals for healthy vending.
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APPENDICIES
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Appendix A
Vending products meeting Smart Snack criteria will be marked with apple sticker by
selection #.
Cling form sticker with Smart Snack information will be placed on outside of vending
machines.
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Appendix C
Activities
Resources:
Managers
Staff
Healthy Vending
Toolkit
Collaborations:
KCHD
ET Wellness
Roundtable
Planning:
Monthly meetings
Discuss progress and
sustainability of
vending policy
Assessment of worksite
environment
Interviews/Inquiries
with
stakeholders
Learning
Interviews/Inquiries
with vendors
Clarify policy &
healthy changes
proposed by business
Develop assessment
tools used to assess
and evaluate
1. Vending Machines
2. Perception of
stakeholders
Pilot test progress and
sustainability of
vending policy at the
worksite and make
adjustments as needed
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OUTCOMES
OUTPUTS
INPUTS
Reach
Vending Machine
Consumers
Vendors
Stakeholders in
East Tennessee
Short/Medium
Awareness by
stakeholders,
vendors &
managers
Improve knowledge
& awareness of
healthy foods
Strengthen support
of the stakeholders
Advocate for
enforcing policy
Develop best
practices and
implementation
guidelines for
vendors, worksite
staff and consumers
Long-term
Establish
environmental
changes that
increase access
and availability
of healthy foods
for employees at
the worksite.
Adoption of healthy
vending policy
Business wide
implementation and
sustainability of
healthy vending
machine policy
Adapted using Bay Area/San Diego and Imperial Regional Nutrition Network Vending Machine Toolkit as a mode (16).
Appendix D
5 Key Elements for Creating a Successful Vending Policy
Erin Gabel, District Representative
Senator Tom Torlakson, District 7
1. HAVE AN ELECTED CHAMPION
a) Why? Champion will see it through the politics.
b) A champion can be found or madeprior interest in public health, nutrition
helps!
c) Be armed with the information about why this is relevant to obesity issue.
2. WORK CLOSELY WITH PUBLIC HEALTH EXPERTS AND LEADERSHIP
a) From county health department, or universities
b) Create an inventory of current policy or lack thereof:
Is anyone in charge now?
Who regulates or has any jurisdiction, or could?
Make sure those folks are at the table.
3. MAKE THE POLICY REASONABLE
a) Know your priorities early and make sure your champion shares them.
b) Understand that the policy process contains many compromises.
c) Ask yourself:
What is our ultimate goal?
What are we willing to fight for?
What is realistic?
4. MAKE THE POLICY ENFORCEABLE
a) Get all administrators at the table early; keep policy reality-based.
b) Put someone in charge to be held accountable.
c) Have deadlines/timelines for implementation and enforcement.
d) Include regular reporting to authorizing agencies (Board of Sups, etc) to keep it
on the radar.
5. HAVE YOUR VENDING POLICY BE MORE THAN AN END USE IT AS A
MEANS/OPPORTUNITY FOR EDUCATION
a) Puts obesity and nutritional health on radar for elected representatives.
b) Follow up and pick a new goal.
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Appendix E
Date: _______________
Manager Assessment Survey
A manager is required to complete this survey. This survey should take you 5-10
minutes to complete.
The purpose of this survey is to gather information about vending machines and
manager perceptions of vending machines at this worksite. Your answers will help in
the development of a healthy vending toolkit.
1. Does your worksite offer vending?
Yes
No STOP, You may submit this survey.
If yes, please specify vendors
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
2. Who is responsible for managing food and beverages in the vending machines(s)?
(Please note and be specific)
Managers
Other (please specify)
_____________________________________________________________________________________________________
3. Does your worksite make a conscious effort to stock beverage items modified to be
lower in calories and/or made with at least 50% juice with no added sweeteners?
For example, Coke zero has zero calories and uses aspartame, artificial sweetener. It is
considered a modified item.
Yes
No
Other (please specify)
_____________________________________________________________________________________________________
4. Does your worksite make a conscious effort to stock food items modified to be lower in
calories and fat or provide more fiber?
For example, baked lays potato chips are modified because it is lower in calories and
fat.
Yes
No
Other (Please specify)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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Appendix F
Date: ________________
Employee Assessment Survey
This survey should take 5-10 minutes to complete.
The purpose of this survey is to gather information about employee perception of
vending machines at their worksite. Your answers will help support a healthy work
environment.
1. How many times per week to you buy food and/or beverage from vending machines?
less than once a week
1-2 times per week
3-4 times per week
5-6 times per week
7 or more times per week
WHAT YOU LOOK FOR
2. When making a choice at a vending machine, how important is: (Mark one box for each
item)
Not at all
important
Somewhat
important
Very
important
If no, what could be done to help you make healthier food/beverage choices?
_________________________________________________________________________________________________________
5. If healthy food options were made available to you (such as baked chips, diet sodas, low
calorie juices/drinks, water/flavored water, granola bars, low fat baked cookies and
goods, low fat dairy products) would you purchase them?
Yes
No
Other comments:________________________________________________________________
Please answer the question below
6.
Strongly
Disagree
Disagree Neither
agree or
disagree
Agree Strongly
Agree
Strongly
Disagree
Disagree Neither
agree or
disagree
Agree Strongly
Agree
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Appendix G
Please complete the survey below. This survey will help us identify foods to put in our
vending machines. Mark the following foods as either You Really Like
or, You Dont Like
FOODS
1. Raisins
2. Animal crackers
3. Nuts & seeds
4. Chex Mix
5. Baked Lays
6. Baked Cheetos
7. Baked Doritos
8. Pretzels
9. Dried fruits
10. Fig Bars
11. Diet coke
12. Diet Pepsi
13. Flavored water
14. Diet Sprite
15. Powerade
16. Orange Juice
17. Apple Juice
18. Cranberry Juice
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, Its Okay
Appendix H
Survey of Worksite Vending Machines
Name of Worksite: _____________________________________________
Date:_________________
# of Slots
in Machine 1
# of Slots
in Machine 2
# of Slots
in Machine 3
# of Slots
in Machine 4
# of Slots
in Machine 5
# of Slots
in Machine 6
Chips* regular
Chips* low-fat or pretzels
Crackers/ Chex Mix
Crackers with cheese or peanut butter
Fruit or vegetable
Granola/cereal bars
Nuts/trail mix
Candy
Cookies/snack cakes/pastries
Low-fat cookies and baked goods
Other food:
Other food:
Total # of slots in vending machine
Beverages
Soda (regular)
Diet soda
Fruit drink (less than 50% real juice)
Fruit juice (at least 50% real juice)
Water
Sports drinks
Iced tea, lemonade, or other sweetened drink
Whole or 2% milk (including flavored)
Low-fat/1% milk or fat-free milk (including
flavored)
Other drink:
Total # of slots in vending machine
*Note: chips=potato chips, tortilla chips, cheese snacks, etc. Comments/Notes:
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Appendix I
Sample Letter to Vendor #1
Dear _________________,
In specify a date , the name of your company passed a Healthy Vending
Machine Policy intended to apply to vending machines in our business,
operated or leased properties. The policy requires that what percentage of the
food and beverage items offered should be considered nutritious as described
in the information enclosed.
The Wellness Committee staff is available to assist each vendor about healthy
food and beverage choices available through wholesale suppliers. We have
included what we consider to be an initial list of such foods and where they
can be obtained. This list is not inclusive of all the healthy choices that may be
available and we would be happy to review and add approved items as
needed.
To assist the consumer in identifying items in machines meeting the nutrition
standards, we are asking you to designate at least half or more slots for
healthy offerings and identify these slots with a sticker (apple). In addition,
please place the enclosed poster in a highly visible location at the machine.
The poster explains which items meet the nutrition standards. Periodically,
the vending machines will be surveyed to see if the posters and stickers are in
place and whether items in the designated slots meet the nutrition standards.
We would like all vending machines to be in compliance before specify a date.
If you are having difficulty obtaining approved items or need other assistance,
please contact us. Thank you for your participation in making healthy choices
available for our employees.
Sincerely,
Name:
Business Name:
Telephone Number:
E-mail Address:
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Appendix J
Sample Letter to Vendor #2
Dear_____________,
In an effort to improve the health of our employees, the Wellness Committee
at state name of company would like to improve the selection of healthy items
in our vending machines. Below is a list of sample healthy options that we are
interested in including in our vending machines.
Dried Fruit
Pretzels
Baked Chips
Low-fat popcorn
Diet Sodas
100% fruit juices
Water
This list is not inclusive of all the healthy choices that may be available and we
would be happy to review and add approved items as needed.
Please contact us immediately to discuss this further. Thank you.
Sincerely,
Name:
Business Name:
Telephone Number:
E-mail Address:
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Appendix K
Healthy Snacks
Baked chips
Animal Crackers
Graham Crackers
Pretzels
Nuts and seeds (plain & with spices)
Trail mix (plain)
Dried fruit (raisins, dried cranberries, or other fruit)
Fruit Snacks
Fat-free popcorn
Yogurt
Granola/cereal bars
Low fat cookies
Beverages
Juice- fruit or vegetable
Water (plain or flavored)
Diet sodas (coke zero etc.)
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Appendix L
Evaluation Survey for Vending Machine User
1. Please indicate your current primary position: ____________________________
2. How long have you been an employee here: _____________________________
3. Please mark your answer to the following questions about vending
machines:
Agree
Somewhat
Agree
Disagree
Other comments:
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REFERENCES
1. Allender S., & Rayner M. The burden of overweight and obesity-related ill health in the
UK. Obes Res. 2007; 8: 467-473
2. Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan LK. Impact of nutrition
environmental interventions on point of purchase behavior in adults: a review. Prev Med.
2004; 39: S108 S136.
3. United States Department of Health and Human Services. Healthy People 2010:
Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing
Office; 2000.
4. Popkin BM., Duffey K., Gordon-Larsen P. Enviornmental influences on food choice,
physical activity and energy balance. Physiol & Behav. 2005; 86: 603-613
5. Ogden CL, Flegal K, Carroll M, Johnson C. Prevalence and Trends in Overweight Among
US Children and Adolescents, 1999-2000. J Am Med Asso. 2002; 288: 1728-1732.
6. Tennessee Department of Health. Tennessees Behavioral Risk Factor Surveillance
System 2007. In http://health.state.tn.us/statistics/brfss.htm, January 23, 2009.
7. The Look AHEAD Research Group. Look AHEAD (Action for Health in Diabetes): design
and methods for a clinical trial of weight loss for the prevention of cardiovascular disease
in type 2 diabetes. Contr Clin Trias. 2003; 24: 610-628.
8. American Cancer Society. In http://www.cancer.org/docroot/home/index.asp. January
23, 2009.
9. American Heart Association. In
http://www.americanheart.org/presenter.jhtml?identifier=1200000. January 23, 2009
10. Pratt CA, Lemon SC, Fernandez ID, Goetzel R, Beresford SA et al. Design Characteristics
of Worksite Environmental Interventions for Obesity Prevention. Obes Res. 2007; 15: 2171
2180.
11. Knox County Health Department & East Tennessee Regional Health Office. Achieving
Healthy Weight in East Tennessee: Recommendations for schools, worksites, healthcare
systems, and communities. 2005; 17-20.
12. Fiske A, Cullen K. Effects of promotional materials on vending sales of low-fat items in
teachers lounges. J Am Diet Asso. 2004; 90-93.
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13. French SA, Jeffery RW, Story M, Breitlow, Baxter JS et al. Pricing and promotion effects
on low-fat vending snack purchases: the CHIPS study. Am J Public Health. 2001; 91: 112
117.
14. Kille B. Healthy employees are more productive employees. Presentation delievered at
Great Lakes Regional Cardiovascular Health Conference, 2003.
15. U.S. Department of Health & Human Services. Dietary Guidelines for Americans, 2005.
In http://www.health.gov/DietaryGuidelines/dga2005/document/, March 13, 2009.
16. McKenzie. Planning Implementing & Evaluating: Health Promotion Programs. Pearsons
Education Inc, San Francisco, CA, 2009
17. Bay Area/San Diego and Imperial Regional Nutrition Network Vending Machine
Toolkit. In http://www.banpac.org/healthy_vending_machine_toolkit.htm/. March 4,
2009
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