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State of Wellness Healthy Vending Programs


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State of Wellness Healthy Vending Programs

  2. 2. Nutrition Environment Measures Survey Vending - NEMS-V <ul><li>Developed to assess workplace vending machines </li></ul><ul><li>Based on the Institute of Medicine’s (IOM) nutrition standards for schools </li></ul><ul><li>Intended to have an easy to use coding system: red , yellow and green </li></ul>
  3. 3. NEMS-V: Development & Pilot-testing <ul><li>Developed by Susan Klein of Iowa State University Extension and Carol Voss of the Iowa Department of Public Health </li></ul><ul><li>Funding provided by the Wellmark Foundation </li></ul><ul><li>Consulted with NEMS staff - Karen Glanz, PhD, MPH and Margaret Clawson, MPH, UPenn </li></ul><ul><li>$500 mini-grants provided to 11 communities in May 2010 to complete assessments, report findings to coalition or wellness committee, and determine next steps </li></ul><ul><li>$1,000 mini-grants awarded in spring 2011 – 6 focused on vending </li></ul><ul><li>Reliability testing completed in September, 2011 </li></ul>
  4. 4. NEMS-V Coding <ul><li>RED food and beverages are not as healthy and fall outside the Dietary Guidelines for Americans.  </li></ul><ul><li>YELLOW food and beverages are healthy foods that meet the Dietary Guidelines, but do not provide a serving of fruit, vegetable, low-fat dairy or whole grain .  </li></ul><ul><li>GREEN food and beverages are considered the healthiest, are consistent with the Dietary Guidelines for Americans and provide a serving of fruit, vegetable, low-fat dairy or whole grain.  </li></ul><ul><li>A healthy choice calculator is available on website if one can’t figure out if the product is coded red, yellow or green. </li></ul>NEMS-V Coding
  5. 5. Green Food Criteria <ul><li>Green - Provides at least one serving of fruit, vegetable, and/or whole grains or non-fat/low-fat dairy products and meets the Dietary Guidelines for Americans. </li></ul><ul><li>Must also meet all of the following criteria: </li></ul><ul><li>≤ 200 calories per portion as packaged </li></ul><ul><li>No more than 35 percent of total calories from fat </li></ul><ul><li><10 percent of total calories from saturated fat </li></ul><ul><li>Zero trans fat (less than or equal to 0.5 grams per serving </li></ul><ul><li>≤ 35 percent of calories from total sugars, except for yogurt with no more than 30 grams of total sugars, per 8 oz portion as packaged </li></ul><ul><li>Sodium content of 400 mg or less per portion as packaged </li></ul>
  6. 6. Yellow & Red Food Criteria <ul><li>Yellow – Criteria is the same as Green , but does not provide at least one serving of fruit, vegetable, and/or whole grains or non-fat/low-fat dairy products, but also does meet the Dietary Guidelines for Americans. </li></ul><ul><li>Red - Does not meet green or yellow criteria. </li></ul>
  7. 7. <ul><li>Vending Location Cover Page: 9 questions about worksite and vending machines (who stocks, gets profit, etc.) </li></ul><ul><li>Individual Machine Cover Page: 9 questions related to the machine (type of machine, location, accessibility, etc.) </li></ul><ul><li>Individual Machine Graphic: Tracks the number and products to record for each machine. </li></ul><ul><li>Food & Beverage Recording Sheet: record each item, size, price, category of beverage, fruit/vegetable/refrigerated, salty, sweet, ns entrees/sandwiches, and its NEMS-V code. </li></ul>NEMS-V Tool
  8. 8. NEMS-V Website <ul><li> </li></ul><ul><li>Website intended to guide an employee of a company through all of the steps from the initial assessment to how to go about changing some of the products in the machines. </li></ul><ul><li>Tips and guidance are offered on how to communicate with a vendor (the stocker of the machine) and renegotiate the contract. </li></ul><ul><li>Success stories are highlighted. </li></ul>
  9. 9. NEMS-V Website Features <ul><li>NEMS-V Tools Tutorial : 15 minute online demonstration on how to complete a NEMS-V assessment </li></ul><ul><li>NEMS-V Healthy Choices Calculator Tutorial : 5 minute online demonstration on how to use the Healthy Choices Calculator to determine green, yellow, or red food/beverage choices </li></ul><ul><li>Ready to complete graphic for displaying vend #, color code and/or calories for each machine </li></ul>
  10. 10. NEMS-V Website Features <ul><li>Provides an award certificate for each machine and the location </li></ul><ul><ul><li>Bronze award - if at least 30% of the food or beverage choice are yellow or green; </li></ul></ul><ul><ul><li>Silver award if at least 40% are yellow or green; </li></ul></ul><ul><ul><li>Gold award if at least 50% are yellow or green and without unhealthy advertising </li></ul></ul><ul><li>Generates a report card for each machine and location </li></ul><ul><ul><li>Indicates how many food and beverage items need to be changed to green or yellow choices to earn a Bronze, Silver or Gold award </li></ul></ul><ul><ul><li>Provides a checklist of action steps for making healthier choices available in vending machines </li></ul></ul>
  11. 11. Reliability Testing <ul><li>Results demonstrate that the website tutorial can be an effecting teaching tool and that the NEMS-V assessment tool is reliable. </li></ul><ul><li>There was high percentage of agreement for both product and color between rater groups (A versus B) and time (time 1 versus time 2). </li></ul><ul><li>While both product and color agreements have reliable results; the product agreement is relatively higher than the color agreement. </li></ul>
  12. 12. Mini Grant Worksite Successes <ul><li>Four projects focused on buildings that house county employees and non-profit organizations. NEMS-V assessments in 13 buildings with 46 vending machines. </li></ul><ul><li>Two projects focused on businesses in four different counties, completing 132 NEMS-V assessments in 16 businesses. </li></ul><ul><li>The State Employee Wellness committee used funds to pilot a produce cart in three State office buildings. </li></ul>
  13. 13. Success Story <ul><li>NEMS-V was used to survey vending machines </li></ul><ul><li>located in Dallas County buildings. Dallas </li></ul><ul><li>County house 6 vending machines, including 4 </li></ul><ul><li>beverage and 2 snack. The assessment </li></ul><ul><li>showed there were no yellow or green snack </li></ul><ul><li>foods. The Sherriff’s office is responsible for filling the machines. A resolution was passed in December, 2011, by the Board of supervisors stating that food and beverages sold in vending machines on Dallas County property will offer a minimum of 30% healthier choices as determined by the NEMS-V. guidelines. </li></ul><ul><li>Similar resolutions are currently being drafted for Linn and Scott Counties. </li></ul>Dallas County, Iowa
  14. 14. Next Steps for NEMS-V <ul><li>Social marketing planning process to motivate individuals to make healthy choices in the vending machines </li></ul><ul><ul><li>Conduct interviews at worksites </li></ul></ul><ul><ul><li>Online focus groups </li></ul></ul><ul><ul><li>Message development </li></ul></ul><ul><ul><li>Testing </li></ul></ul>
  15. 15. Focus Group Findings <ul><li>White Collar Employees were very likely to say they paid attention to nutrition labels with 19 of 24 (79%) in the respondent sample saying they looked at labels at least some of the time. </li></ul><ul><li>  White collar respondents were more often “rationalizing” their snack indulgences, either because it was the “wiggle room” in their overall approach to eating or because they exercised regularly which allowed for their indulgences. </li></ul>
  16. 16. Focus Group Findings (cont.) <ul><li>Many respondents seemed to give themselves permission to ignore everything they know about nutrition and just pick “junk”. Others visit the vending area with very low expectations for nutritious offerings, leaving empty-handed or generally avoiding the vending machines altogether. </li></ul><ul><li>Respondents said “sometimes you just NEED CHOCOLATE!” One of the most frequently selected snacks and most ardently defended was chocolate – Snickers and M&M’s were popular in this category. </li></ul>
  17. 17. Nearly 6 in 10 respondents thought message worked best to communicate the snack rating system clearly. <ul><li>Respondents liked that it illustrated examples of foods, which made the color coding system very clear. </li></ul><ul><li>The main message was focused on encouraging people to choose better snacks at least some of the time. </li></ul><ul><li>Many noted they had never seen vending machines with healthy options stocked in them. </li></ul>Message Selected
  18. 18. Sustaining Healthy Vending <ul><li>Project will lead to having a policy in place for state facilities to provide a minimum of 30% of food and beverage choices in vending machines as healthy options based on NEMS-V criteria </li></ul><ul><li>Project will serve as a model for other businesses across the state. </li></ul>
  19. 19. Insights from Iowa <ul><li>Constant communication with vendors is crucial </li></ul><ul><li>30% of items as healthy choices is reasonable for change </li></ul><ul><li>Incentives may reinforce healthy vending choices </li></ul><ul><li>May help to associate with another wellness event – Live Healthy Iowa 100-day challenge </li></ul><ul><li>Employee input on healthy choices can get their buy-in </li></ul><ul><li>More and more tasty products are available </li></ul><ul><li>Set your sights at a reasonable level – beverages are already there; shelf stable is a good place to start </li></ul>
  20. 20. NEMS-V Website <ul><ul><li> </li></ul></ul><ul><ul><ul><li>Intended to be a complete training tool, from initial assessment to implementing changes </li></ul></ul></ul>
  21. 21. IOWA DEPARTMENT OF PUBLIC HEALTH IOWANS FIT FOR LIFE CAROL VOSS 515-244-5566 [email_address] SUSAN KLEIN 515-240-0368 [email_address]
  23. 23. Healthy Vending Machine Project <ul><li>Increase access to healthy foods and beverages and reduce or eliminate the availability of calorie dense, nutrient poor foods in public service venues </li></ul>
  24. 24. Healthy Vending Machine Project <ul><li>Getting started: </li></ul><ul><ul><li>Built on the school vending machine policies </li></ul></ul><ul><ul><li>Built on the state wellness discount </li></ul></ul><ul><ul><li>Snack and beverage machines – state run buildings/offices </li></ul></ul><ul><ul><li>Target audience – state employees </li></ul></ul><ul><ul><li>Indirect audience – the public </li></ul></ul>
  25. 25. Healthy Vending Machine Project <ul><li>WHY? </li></ul><ul><li>33% of active state employees are OVERWEIGHT </li></ul><ul><li>48% of active state employees are OBESE </li></ul>
  26. 27. State Employees in Comparison to the General Population
  27. 28. Healthy Vending Machine Project
  28. 29. Healthy Vending Machine Project <ul><li>Culture change! </li></ul>
  29. 30. Healthy Vending Machine Project <ul><li>What we wanted to do… </li></ul><ul><li>Create a healthy vending machine policy that included healthier items in machines in state offices </li></ul>
  30. 31. Healthy Vending Machine Project <ul><li>Getting started… </li></ul><ul><li>Key Partners: </li></ul><ul><li>Alabama Department of Rehabilitative Services </li></ul><ul><li>Business Enterprise Program </li></ul>
  31. 32. Healthy Vending Machine Project <ul><li>Key Partners Continued: </li></ul><ul><li>Alabama State Department of Education </li></ul><ul><li>Governor’s Office </li></ul><ul><li>Alabama Department of Agriculture and Industries </li></ul><ul><li>Alabama Department of Public Health </li></ul><ul><li>State Employees Insurance Board </li></ul><ul><li>State Obesity Task Force </li></ul><ul><li>University of Alabama </li></ul>
  32. 33. Healthy Vending Machine Project <ul><li>Getting started…. </li></ul><ul><li>Collaborated with Alabama Department of Rehabilitation Services (ADRS) and their Business Enterprise Program </li></ul><ul><ul><li>Emphasized that funding was available to provide subsidies to vendors if profit losses occurred </li></ul></ul><ul><ul><li>Negotiated implementation terms (% items, price, placing of items, etc.) </li></ul></ul>
  33. 34. Healthy Vending Machine Project <ul><li>Initial policy: </li></ul><ul><li>50% of the items in the machines will be healthy snacks that meet nutrition criteria </li></ul>
  34. 35. Healthy Vending Machine Project <ul><li>Nutrition Criteria: </li></ul><ul><li>10% or less of the Daily Value (DV) of total fat (nuts and fruits are exceptions) </li></ul><ul><li>10% or less of the Daily Value (DV) of total carbohydrate (nuts and fruits are exceptions) </li></ul><ul><li>5% or more of the Daily Value (DV) of at least one of the following nutrients: fiber, Vitamin A, Vitamin C, calcium, iron </li></ul><ul><li>360 mg or less of sodium </li></ul>
  35. 36. Healthy Vending Machine Project <ul><li>Nutrition Criteria cont. </li></ul><ul><li>Preferred beverages include pure water, non- carbonated flavored and vitamin enhanced water (without artificial flavorings), 100% fruit and/or vegetable juice (without artificial sweeteners) and diet soda. </li></ul>
  36. 37. Healthy Vending Machine Project <ul><li>Pilot project… </li></ul><ul><li>Identified partner agencies to implement the policy </li></ul><ul><ul><li>ADRS, Capitol, Agriculture & Industries, ADPH </li></ul></ul><ul><ul><li>Dept of Education - vendors not agreeable </li></ul></ul><ul><ul><li>Invited private entities to participate- no responses </li></ul></ul><ul><li>Met with Vendors-individually </li></ul><ul><li>Worked with evaluator from the University of Alabama to develop a vending machine assessment </li></ul>
  37. 38. Healthy Vending Machine Project <ul><li>Lunch & Learn education sessions provided in pilot agencies </li></ul><ul><ul><li>Taste testing </li></ul></ul><ul><li>Worked with UA to develop an employee snacking survey- sent out in early October </li></ul><ul><li>Pilot project started October 2010 </li></ul>
  38. 39. Healthy Vending Machine Project <ul><li>Graphics developed for marketing: </li></ul><ul><ul><li>Logo </li></ul></ul><ul><ul><li>Good Choice Stickers </li></ul></ul><ul><ul><li>Table tents to give tips and test snacking knowledge </li></ul></ul><ul><ul><li>Flyers </li></ul></ul><ul><ul><li>Posters with Good Choice information </li></ul></ul>
  39. 40. Healthy Vending Machine Project <ul><li>Healthy snacks are identified with a Good Choice sticker </li></ul><ul><li>Machines and break rooms contain Good Choice materials (table tents, posters, machine toppers, flyers) </li></ul>
  40. 42. Healthy Vending Machine Project <ul><li>Developed a Webpage </li></ul><ul><ul><li> </li></ul></ul><ul><ul><ul><li>Click on Vending Machines </li></ul></ul></ul><ul><ul><li>Suggested marketing materials for worksites to use </li></ul></ul><ul><ul><li>Policy and suggested guidelines for implementation </li></ul></ul><ul><li>Media person for sustainability </li></ul>
  41. 43. Healthy Vending Machine Project <ul><li>The bottom line…….SALES </li></ul><ul><li>Tracking sales data since beginning of pilot </li></ul><ul><li>Comparing current sales to sales from 1 year ago </li></ul>
  42. 44. Healthy Vending Machine Project <ul><li>There were losses initially </li></ul><ul><ul><li>0-31% </li></ul></ul><ul><li>Possible causes: </li></ul><ul><li>Change </li></ul><ul><li>Negative attitudes </li></ul><ul><li>Economy </li></ul><ul><li>Employee complaints (burn out, product availability </li></ul>
  43. 45. Healthy Vending Machine Project <ul><li>Other challenges: </li></ul><ul><li>Reimbursement (invoices) </li></ul><ul><li>Vendors are upset </li></ul><ul><li>Mixed support from ADRS </li></ul>
  44. 46. Healthy Vending Machine Project <ul><li>Actions taken: </li></ul><ul><li>Additional employee in-services </li></ul><ul><li>Employee survey </li></ul><ul><li>Meeting with ADRS accountant </li></ul><ul><li>Follow up meetings with vendors </li></ul><ul><li>Revised Policy: </li></ul><ul><ul><li>30-100% of items in the machine will meet the nutrition criteria </li></ul></ul>
  45. 47. Healthy Vending Machine Project <ul><li>Successes: </li></ul><ul><li>Losses are not as bad as predicted </li></ul><ul><li>Sales are improving, with trend of less loss noted </li></ul><ul><li>Additional, unexpected participants/partners </li></ul><ul><li>(Canteen, Baptist Health Systems, Greil Hospital, East Alabama Medical Center, AlaHA, City of Montgomery, Jackson Hospital, etc.) </li></ul><ul><li>A model policy for the Strategic Alliance </li></ul><ul><li>and their wellness toolkit </li></ul>
  46. 48. Healthy Vending Machine Project <ul><li>Next steps….. </li></ul><ul><li>Short term goal </li></ul><ul><ul><li>Expanding to three additional state agencies this fall </li></ul></ul><ul><ul><li>Long range goal </li></ul></ul><ul><ul><ul><li>Expand to all state agencies at state and county level offices </li></ul></ul></ul>
  47. 49. Healthy Vending Machine Project <ul><li>Request Executive Order from the Governor – </li></ul><ul><li>Feb. 2012 (REVISING) </li></ul>
  48. 50. Healthy Vending Machine Project <ul><li>Teresa B Fair, RD, LD </li></ul><ul><li>Alabama Department of Public Health </li></ul><ul><li>Nutrition and Physical Activity Division </li></ul><ul><li>[email_address] </li></ul>