Healthy Vending Toolkit

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Healthy Vending Toolkit

  1. 1. University of Tennessee Knoxville Knox County Health Department Department of Nutrition Healthy Vending Toolkit A Guide for Healthy Vending at your worksite! Coordinated by: Lusi Martin, Public Health Nutrition Graduate Student Sarah Fisher, RD, MS-MPH 1|Page DEVELOPED MARCH 2009
  2. 2. TABLE OF CONTENTS INTRODUCTION 3 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 APPENDICES 13 * 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 REFERENCES 29 2|Page
  3. 3. 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. 3|Page
  4. 4. 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 etc. (7,8,9). 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 4|Page
  5. 5. 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. 5|Page
  6. 6. 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 employees. 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 6|Page
  7. 7. interventions summarize the findings and identify areas for future research. Methods: 38 articles published between 1970-June 2003 that included a nutrition intervention with an environmental or policy component. 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 addressed. 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 adult population. 7|Page
  8. 8. 4. Fiske and Weber Cullen (2004). Effect of promotional materials on vending machines sales of low-fat items in teacher’s lounges (12). Populations: Adults/schools/Teachers 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. 8|Page
  9. 9. 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 exempt 100% juice are exempt 100% juice contains no added sweeteners; contributes to the recommended 5-A-Day Table 1: Smart Snack Criteria & Rationale 9|Page
  10. 10. 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 committee meetings! 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). 10 | P a g e
  11. 11. 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. 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. 11 | P a g e
  12. 12. 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. 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) 12 | P a g e
  13. 13. APPENDICIES 13 | P a g e
  14. 14. Appendix A 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 selection #.  Cling form sticker with “Smart Snack” information will be placed on outside of vending machines. 14 | P a g e
  15. 15. Appendix B : Smart Snack Flyer posted on vending machines (PDF file) 15 | P a g e
  16. 16. Appendix C 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 Planning: habits  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 sustainability of 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. 16 | P a g e Adapted using Bay Area/San Diego and Imperial Regional Nutrition Network Vending Machine Toolkit as a mode (16).
  17. 17. 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 made—prior 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. 17 | P a g e
  18. 18. 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 lay’s potato chips are modified because it is lower in calories and fat.  Yes  No  Other (Please specify) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 18 | P a g e
  19. 19. 5. Why do you have vending machines at this worksite?  Bring money into your business  Support the business  For the employees PleaseExplain:________________________________________________________________________________________ _________________________________________________________________________________________________________ 6. Does the worksite have a policy regarding sweetened beverage placed in vending machines?  Yes  No If yes, please explain:________________________________________________________________________________________________ _________________________________________________________________________________________________________ 7. Does the worksite have a policy regarding nutrition standards for food items in vending machines?  Yes  No 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?  Yes  No 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). 19 | P a g e
  20. 20. 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 Somewhat Very important important important Trying a snack I’ve never had before Snack taste Snack price 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?  Yes  No 4. Are you able to distinguish healthier foods and beverages at your worksite vending machines?  Yes  No 20 | P a g e
  21. 21. 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 Neither Agree Strongly Disagree agree or Agree disagree 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 disagree 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 machines?  None  $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 vending machines? 21 | P a g e
  22. 22. 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 , It’s Okay or, You Don’t Like Feel free to add other food you would 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 22 | P a g e
  23. 23. Appendix H 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 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 # of Slots # of Slots # of Slots in Machine 4 in Machine 5 in Machine 6 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: 23 | P a g e
  24. 24. 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: 24 | P a g e
  25. 25. 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 Diet Sodas Pretzels 100% fruit juices Baked Chips Water Low-fat popcorn 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: 25 | P a g e
  26. 26. Appendix K 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 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.) 26 | P a g e
  27. 27. 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: Somewhat 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 healthy 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 machines? Other comments: 27 | P a g e
  28. 28. 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. 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 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. 28 | P a g e
  29. 29. 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 29 | P a g e

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