University of Tennessee Knoxville Knox County Health Department
Department of Nutrition
Healthy Vending Toolkit
A Guide for Healthy Vending at your
Lusi Martin, Public Health Nutrition Graduate Student
Sarah Fisher, RD, MS-MPH
DEVELOPED MARCH 2009
TABLE OF CONTENTS
WHY DO WE WANT HEALTHY VENDING IN WORKSITES? 4
LITERATURE REVIEW ON HEALTHY VENDING 6
BACKGROUND INFORMATION ON HEALTHY 9
VENDING POLICY IN KNOX COUNTY
STEPS FOR HEALTHY VENDING AT THE WORKSITE 10
* 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
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.
WHY DO WE WANT HEALTHY VENDING IN WORKSITES?
In the United States, overweight and obesity continues to be a major public
health problem and a health issue that consumes a significant amount of
healthcare dollars (1). Evidence suggests that the rise in overweight and
obesity in the U.S. has been attributed to changes in the environment that
have influenced both eating and physical activity (4). Unfortunately, this
rising trend in overweight and obesity has been predicted to continue both in
adults and in children (5). According to reports from the Behavioral Risk
Factor Surveillance Systems, in 2006, 61.1% of the adult population in the U.S
was overweight and/or obese, rising to 62.9% in 2007 (6). This trend is a
major concern that needs attention as overweight and obesity are linked to
many known chronic diseases such as heart disease, type II diabetes, cancer
Major trends in the U.S. food environment are partly to blame for this
overweight and obesity problem including the almost unlimited access to fast
food restaurants and the wide availability of high calorie/high fat foods.
According to Popkin et al, it appears that total caloric intake has increased
among all races, ages, socioeconomic backgrounds and genders (4). In
addition, these trends are the result of the frequent consumption of snack
foods that are energy dense and contain few nutrients. These foods are
prepackaged and are usually considered convenient for an individual to
consume/purchase immediately without much preparation. Therefore,
Seymour et al. suggest that targeting the individuals is not as effective as
targeting environmental and policy interventions to achieve a change in
dietary pattern by making less healthy foods less available to individuals (2).
Healthy People 2010 Objectives have documented the need for worksite
interventions, an environment where there is a unique opportunity to
improve employees’ health (2,3). In addition, efforts at the national level have
been made focusing on the worksite. For example, the National Heart Lung
and Blood Institute (NHLBI) have funded 7 studies focusing on obesity
prevention in 114 worksites with about 48,000 employees (10). The worksite
environment in particular has been viewed as an environment that offers a
unique opportunity to promote healthy changes among individuals (11). The
larger community is saturated with advertisement and eatery places that cue
individuals to increase consumption. The worksite however, is a much
smaller community that can be easily influenced and/or manipulated to assist
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 teacher’s 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.
LITERATURE REVIEW ON HEALTHY VENDING
1. Kille B (2003). Healthy Employees are More Productive Employees(14).
Population: The heart healthy labeling program was institutionalized in
all worksites serviced by Maumee Valley Vending.
Objective(s): Henry County Heart Health Coalition in Ohio and Maumee
Valley Vending, Inc. collaborated to determine whether a 5 a
Day labeling program on vending machines would increase
consumption of heart healthy foods by worksites
Methods: Cold machine items were labeled with a heart healthy or 5
a Day sticker as they came off the production line. In snack
machines, “Healthy Vending Choices” static clings were
placed on the front glass of machines to assist customers
with selections, and beverage machines promoted healthy
items through educational information
Findings: An evaluation from March through September 2003
indicated an 80% increase in the sale of heart healthy items
and a 14 percent increase in 5 a Day items. Survey
indicated that 100 percent of the companies believed that
having access to healthy food choices in vending machines
is beneficial and 57% of employees used the program to
identify Heart Health and/or 5 a Day foods to purchase.
2. Seymour et al (2004). Impact of nutrition environmental interventions
on point-of-purchase behavior in adults: a review (2).
Population: Adult populations
Objective(s): A meta-analysis to identify strengths and weaknesses of
the research related to environmental and policy nutrition
interventions summarize the findings and identify areas for
Methods: 38 articles published between 1970-June 2003 that
included a nutrition intervention with an environmental or
Findings: Worksite and University settings have the most potential
for success. Interventions in grocery stores show to be the
least effective. Concerns about health and taste of food
promoted were rarely considered and should be in the
future. Sustainability of environmental change was never
3. French SA, et (2001). Pricing and promotion effects on low-fat vending
snacks purchases: The CHIPS Study(13).
Population: Adults & Children, Schools and Worksites
Objective(s): To examine the effects of pricing and promotion strategies
on purchases of low-fat snacks from vending machines.
Methods: Low-fat snack items were added to 55 vending machines at
12 secondary schools and 12 worksites. There were four
pricing levels (equal price, 10% reduction, 25% reduction,
50% reduction). There were also 3 promotional conditions
(none, low-fat label, low-fat label + promotional sign). Sales
of low-fat items were tracked continuously for 12 months.
Findings: Price reductions at all levels (10%, 25%, 50%) were
associated with significant increases in sales of low-fat
snacks (9%, 39%, 93% respectively). Promotional signage
was weakly associated with increases in low-fat snack sales.
Pricing and promotion had similar effects on adolescent and
4. Fiske and Weber Cullen (2004). Effect of promotional materials on
vending machines sales of low-fat items in teacher’s lounges (12).
Objective(s): To examine the impact of and environmental intervention
using promotional materials and increasing the availability
of low-fat items on vending machine sales.
Methods: Ten vending machines located at elementary or middle
school teacher’s lounge were randomly assigned to 1 of 3
condition; control, and one of two experimental conditions.
Low fat items were promoted in two ways: labeling
(intervention I) and labeling + signage (intervention II).
Total number of items sold and total revenue was recorded
weekly for 4 weeks.
Findings: An increase in the number of low-fat items sold were seen
from the vending machines sold at intervention level II.
Sales revenue was not reduced as a result of the
increased selection of low-fat items.
BACKGROUND INFORMATION ON HEALTHY
VENDING POLICY IN KNOX COUNTY
In 2006, the Knox County Health Department (KCHD) initiated a healthier
vending machine policy using a three-tiered color-coded system (Red, Yellow,
and Green) for food and beverage items in vending machines as follows: Red
(not healthy), Yellow (somewhat healthy), and Green (the healthiest). The
three-tiered color-coded system allowed for a 30% implementation of healthy
vending. Not surprisingly, the three tiered color-coding system was not
effective in changing employee eating habits as healthier food competed with
unhealthy food options.
As a result, a new Knox County Vending Policy was established and has been
implemented 100% at KCHD (See Appendix A). Healthy foods are identified
by being a “smart snack”. In order to be a “smart snack”, foods must meet
specific criteria. These criteria are made visible for all consumers on a cling
form sticker posted on the outside of each vending machine (Appendix B). In
addition, a “smart snack” apple sticker is used to identify each vending
product meeting “smart snack” criteria. Rationales for the “Smart Snack”
criteria are provided in the table below based on the 2005 Dietary Guidelines
for Americans (15). The new Knox County vending policy was established to
impact vending machines for Knox County government offices. Other facilities
with vending machines have not fully implemented the New Knox County
Vending Policy including the City County Building located in downtown
Knoxville who house hundreds of employees at the worksite. This location has
implemented the “smart snack” program at 30% instead of 100%.
Smart Snack Criteria Rationale
5g or less of Total Fat High amounts associated with higher calorie foods and
saturated fat intake
2g or less of Saturated High amounts associated with elevated blood lipids (cholesterol,
Fat triglycerides, LDL, low HDL) which can lead to heart disease
30g or less of sugar Add calories w/no nutrient
Nuts and seeds are Nuts and seeds contain heart healthy fats
100% juice are exempt 100% juice contains no added sweeteners; contributes to the
Table 1: Smart Snack Criteria & Rationale
STEPS FOR HEALTHY VENDING AT THE WORKSITE
I. POLICY DEVELOPMENT AND PLANNING
Step 1: Develop a Wellness Committee: this committee should be
representative of the various sites and/or department at your worksite. This
team should consist of a group of individuals who have an interest in
promoting a healthy work environment including healthy vending. The
committee should meet regularly to discuss a timeline for implementation of
healthy vending. In addition, it would be helpful to have a public health
nutritionist (e.g. KCHD) available who can offer opinions and assist with the
planning process. Use the information presented in the following sections to
help jump-start or strengthen healthy vending at your worksite wellness
Step 2: Develop a Logic Model: A logic model is a “simplified picture of a
program, initiative, or intervention that shows the logical relationship among
the resources that are invested, the activities that take place, and the benefits
of changes that result- a roadmap” (16). A logic model would be helpful
during the planning for implementation phases. Use the example logic model
in Appendix C to guide you when planning for implementing healthy vending
policy at the worksite
Step 3: Use KCHD Healthy Vending Policy Guidelines in Appendix A as a
model for your worksite healthy vending program.
Step 4: Identify opportunities and possible threats early on, then brainstorm
ideas to capitalize on opportunities and problem solve threats. The worksite
offers a unique opportunity to implement healthy vending as it is a smaller
environment that can easily be modified in comparison to trying to change the
nation’s food environment or regulating fast food restaurants. See Appendix D
for 5 Key Elements for Creating a Successful Healthy Vending Policy (17).
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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. Manager assessment survey (Appendix E)
2. Employee assessment survey (Appendix F)
4. Food Selection Survey (Appendix G)
3. Vending Machine Survey (Appendix H)
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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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
- 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
- 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.
IV. MONITORING AND EVALUATION
Step 7: Periodic process monitoring and evaluation is crucial in ensuring that
you are obtaining regular feedback on how your healthy vending policy is
working at the worksite. From your evaluations, you will be able to adjust
and/or refine the vending policy to make it better for your worksite. Use the
evaluation forms indicated as a guide to monitor and evaluate the progress of
your worksite healthy vending policy.
Vending Machine Survey (Appendix H)
Evaluation Survey for Vending Machine User (Appendix L)
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Snack Smart- New Healthy Vending System
“Smart Snack” criteria for vending products are as follows:
5 grams or less of total fat
2 grams or less of saturated fat
30 grams or less of sugar
Nuts and seeds are exempt
100% Juices are exempt
Vending products meeting “Smart Snack” criteria will be marked with apple sticker by
Cling form sticker with “Smart Snack” information will be placed on outside of vending
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Appendix B : Smart Snack Flyer posted on vending machines (PDF file)
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Logic Model for Healthy Vending at the Worksite
INPUTS OUTPUTS OUTCOMES
Activities Reach Short/Medium Long-term
Resources: Awareness by Change in food items
Managers Assessment of worksite stakeholders, in vending machines
environment Vending Machine
Staff Consumers vendors & Establish
Healthy Vending Interviews/Inquiries managers Reassess,
with stakeholders environmental
Toolkit Learning reimplement and
Vendors changes that
Improve knowledge reevaluate vending increase access
Collaborations: Interviews/Inquiries Stakeholders in & awareness of policy and change as and availability
KCHD with vendors East Tennessee healthy foods necessary of healthy foods
ET Wellness Clarify policy & for employees at
Roundtable healthy changes Strengthen support Change in food the worksite.
proposed by business of the stakeholders choices and eating
Monthly meetings Advocate for
Discuss progress and Develop assessment enforcing policy Adoption of healthy
sustainability of tools used to assess vending policy
vending policy and evaluate Develop best
1. Vending Machines practices and Business wide
2. Perception of implementation implementation and
stakeholders guidelines for sustainability of
vendors, worksite healthy vending
staff and consumers machine policy
Pilot test progress and
vending policy at the
worksite and make
Stakeholders: are individuals who have something to gain or lose from
adjustments as needed
the healthy vending policy. These individuals could be vending machine
users (employees), managers & vendors.
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Adapted using Bay Area/San Diego and Imperial Regional Nutrition Network Vending Machine Toolkit as a mode (16).
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 made—prior interest in public health, nutrition
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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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?
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)
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.
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 lay’s potato chips are modified because it is lower in calories and
Other (Please specify)
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5. Why do you have vending machines at this worksite?
Bring money into your business
Support the business
For the employees
6. Does the worksite have a policy regarding sweetened beverage placed in vending
If yes, please
7. Does the worksite have a policy regarding nutrition standards for food items in vending
Other (please specify):___________________________________________________________
8. Will managers of this worksite be willing to provide and support healthier food and
beverage choices in vending machines for their employees?
9. If yes to question #8, in what ways will you support healthier food and beverage choices
in vending machines? (Please check all that apply, and feel free to add other ideas)
Lower calorie foods and beverages
Lower fat foods and beverages
Lower sugary foods and beverages
Labeling healthy foods
Other (Please specify):________________________________________________________
10. What are some barriers that you think will hinder your efforts to making any changes
to beverages and food items offered in the vending machines at this worksite? (Please list
as many as you can think of).
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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
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
Not at all Somewhat Very
important important important
Trying a snack I’ve never had before
Number of calories in a snack
Amount of fat in a snack
Amount of carbohydrate in a snack
How “healthy” a snack is
Watching my weight
Value for my money
Buying my “usual” snack
How hungry I am
3. Do you think vending machines are part of a healthy environment?
4. Are you able to distinguish healthier foods and beverages at your worksite vending
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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?
Please answer the question below
6. Strongly Disagree Neither Agree Strongly
Disagree agree or Agree
I would like healthy options in
the snack food and beverage
vending machine at work
7. Strongly Disagree Neither Agree Strongly
Disagree agree or Agree
If there were a variety of
healthy snack food and
beverage choices, I would use
these vending machines more
often than I do currently
8. On average, how much do you spend per week on snack foods and beverages in vending
$0.75 - $1.50 per week
$2.00 - $1.50 per week
$4.00 - $6.00 per week
More than $6.00 per week
9. What are some healthy food and beverage choices that are available at your worksite
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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 , It’s Okay
or, You Don’t Like Feel free to add other food you would like.
2. Animal crackers
3. Nuts & seeds
4. Chex Mix
5. Baked Lays
6. Baked Cheetos
7. Baked Doritos
9. Dried fruits
10. Fig Bars
11. Diet coke
12. Diet Pepsi
13. Flavored water
14. Diet Sprite
16. Orange Juice
17. Apple Juice
18. Cranberry Juice
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Survey of Worksite Vending Machines
Name of Worksite: _____________________________________________ Date:_________________
City: _______________________________________________________ State:_______
# of vending machines at Wellness Worksite: _________# of employees:_________
Name of data collector: _____________________________________________________
Snacks # of Slots # of Slots # of Slots
in Machine 1 in Machine 2 in Machine 3
Chips* – regular
Chips* – low-fat or pretzels
Crackers/ Chex Mix
Crackers with cheese or peanut butter
Fruit or vegetable
Low-fat cookies and baked goods
Total # of slots in vending machine
# of Slots # of Slots # of Slots
in Machine 4 in Machine 5 in Machine 6
Fruit drink (less than 50% real juice)
Fruit juice (at least 50% real juice)
Iced tea, lemonade, or other sweetened drink
Whole or 2% milk (including flavored)
Low-fat/1% milk or fat-free milk (including
Total # of slots in vending machine
*Note: chips=potato chips, tortilla chips, cheese snacks, etc. Comments/Notes:
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Sample Letter to Vendor #1
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
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.
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Sample Letter to Vendor #2
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 Diet Sodas
Pretzels 100% fruit juices
Baked Chips 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.
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Guidelines for Healthy Vending
“Smart Snack” criteria for vending products are as follows:
- 5 grams or less of total fat
- 2 grams or less of saturated fat
- 30 grams or less of sugar
- Nuts and seeds are exempt
- 100% Juices are exempt
Nuts and seeds (plain & with spices)
Trail mix (plain)
Dried fruit (raisins, dried cranberries, or other fruit)
Low fat cookies
Juice- fruit or vegetable
Water (plain or flavored)
Diet sodas (coke zero etc.)
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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
Agree Agree Disagree
I am happy with the changes made to the vending
machines at my worksite.
I am aware of the healthier food items available
in the vending machines
I am more aware of healthier food items
I believe the foods in my vending machine are
I understand the vending policy at my worksite
My company feels like my health is important
1. What foods would you like to be added to the vending machines?
2. What foods would you like to be removed from the vending
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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
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. Tennessee’s 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
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
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 –
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,
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