Brief ReportThe Effects of a Nutrition EducationInterven.docx

Brief Report
The Effects of a Nutrition Education
Intervention on Vending Machine Sales
on a University Campus
Mary V. Brown, PhD, CHES; Matthew Flint, PhD; James Fuqua,
BS
Abstract. Objective: To determine the effects of a nutrition
infor-
mation intervention on the vending machine purchases on a col-
lege campus. Participants and Methods: Five high-use vending
machines were selected for the intervention, which was
conducted
in the fall of 2011. Baseline sales data were collected in the 5
machines prior to the intervention. At the time of the
intervention,
color-coded stickers were placed near each item selection to
iden-
tify less healthy (red), moderately healthy (yellow), and more
healthy (green) snack items. Sales data were collected during
the
2-week intervention. Results: Purchases of red- and yellow-
stick-
ered foods were reduced in most of the machines; moreover,
sales
of the green-stickered items increased in all of the machines.
Conclusions: The increased purchases of healthier snack options
demonstrate encouraging patterns that support more nutritious
and

healthy alternatives in vending machines.
Keywords: college students, nutrition intervention, vending
machines
A s college students transition from home life to col-lege life,
often there are nutrition and food chal-lenges that students may
be dealing with for the
first time.
1
These new dietary behaviors often contribute to
the establishment of a life time of either healthy or
unhealthy behaviors.
2
In a national college survey, 34.1%
of college students described themselves as overweight or
obese.
3
Although obesity is a complex issue with a variety
of causes, nutrition and physical activity play a vital role in
managing energy imbalance.
4
In an effort to reduce the obesity epidemic, the Centers
for Disease Control and Prevention developed the Common
Community Measures for Obesity Prevention Project,
5

which was initiated to identify and recommend strategies
related to obesity prevention. The first of 24 strategies rec-
ommended healthier food and beverage choices be made
available in schools and public service venues.
5
More
recently, the National Prevention Strategy unveiled in June
2011 recommended that early learning centers, schools,
colleges, and universities “implement and enforce policies
that increase availability of healthy foods, including in a la
carte lines, school stores, vending machines, and fund-
raisers.”
6(p36)
In addition, the Affordable Care Act now
requires calorie declarations posted near items in vending
machines, with the hope that consumers will make healthier
choices.
7
Several North American school districts have developed
vending machine policies that have been implemented at

the elementary and secondary school level.
8–12
Policies
ranged from turning off machines during the lunch period
8
or limiting accessibility to vending machines,
9,10,12
decreasing the availability of unhealthy foods, increasing
availability of healthier foods,
8
and ensuring foods meet
specific nutritional standards.
12
Few college campuses have
nutrition policies regarding healthy vending.
Vending machines on college and university campuses
are big business. In 2012, approximately 6.6% of the 19.31
billion dollar vending industry were from the university
and college settings.
13
One study that tracked meal and

snacking patterns of university students found that 74% of
Scottish students bought food and drinks from the univer-
sity vending machines.
14
Students often select food based
upon convenience, taste, time, and price,
2
making vending
machines a less healthy, yet quick snack.
According to the Center for Science in the Public Inter-
est, as reported in The Nation’s Health, in a survey of 251
Dr Brown, Dr Flint, and Mr Fuqua are with the Department of
Public and Community Health at Utah Valley University in
Orem,
Utah.
Copyright � 2014 Taylor & Francis Group, LLC
512
JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62,
NO. 7
schools, 73% of beverage options and 83% of snack options
were of poor nutritional quality.

15
In a study of 11 US col-
lege campuses, researchers found that the majority of bev-
erages and snacks were low in fiber, and high in calories,
fat, and sugar.
16
Several interventions have been implemented in vari-
ous settings to increase the purchase of nutritious food
in vending machines. For example, increasing the num-
ber of nutrient-dense snacks and including nutrition
information resulted in a decrease in sales on one uni-
versity campus.
17
Educational materials including labels
and signs placed on vending machines located in
teacher’s lounges on elementary and middle school cam-
puses promoting low-fat items increased the sale of the
healthier items, but did not reach statistical signifi-
cance.
18

Another intervention included environmental pol-
icies such as eliminating regular soda beverages and
decreasing the hours of vending machine operation, which
resulted in a decrease in revenue and commissions in one
school district.
8
In addition, providing healthy vending
choices and nutrition information in the worksite
19
as well
as the health care setting
20
has increased as consumers
demand healthier options. The results of these studies
became the impetus for this study.
This study aimed to determine the effects of a simple
nutrition information intervention on the vending
machine purchases on a college campus. The “Navigate
the Snack Debate” intervention was developed by a
group of undergraduate public and community health

students as an engaged-learning project. Our hypothesis
was that our intervention would increase the purchase of
healthy foods and decrease unhealthy foods purchased
at the vending machine.
METHODS
This study was conducted at a large western public uni-
versity with a student population of 32,000. Although the
Institutional Review Board was contacted, approval was
not necessary to collect data regarding the sales of food
items in the vending machine. The university Dining Serv-
ices Director selected 5 snack vending machines out of the
22 machines (22.7%) on campus. The 5 machines that were
selected were in high-traffic areas and considered “high
use” by Dining Services (one was located in the library, 2
in the Liberal Arts Building, and 2 in the Physical Educa-
tion Building). The unrefrigerated vending machines held
between 35 to 40 snack items each. Prior to the start of the
study, each of the food items in the vending machines were

assessed for their calories, total fat, and saturated fat based
upon the nutrition label. The nonexperimental pretest/post-
test design included a 2-week baseline period that tracked
the sales from all 5 of the machines. All data were collected
early in the fall semester to avoid any special activities (fall
break, basketball season) that might have an impact on
vending sales.
Intervention
Following the baseline data collection period, each item
received a color-coded sticker based upon the “traffic light”
system of red, yellow, or green. Criteria for the color code
was developed using the United States Department of Agri-
culture (USDA) Dietary Guidelines for Americans 2010
21
and the USDA Foods of Minimal Value
22
because of their
use in previous vending research
23,24

as well as recommen-
dations from a registered dietitian (Annette Mica, MS, RD,
LD, e-mail communication, July 2011). Items that received
the red sticker contained more than 250 calories per serving
and/or more than 40% of calories from fat and/or more than
10% of the calories from saturated fat. The yellow-stick-
ered items contained less than 250 calories, but had 30%–
39% calories from fat and/or 5%–9% of calories from satu-
rated fat. The green-stickered items also contained less than
250 calories but had less that 30% of the calories from fat
and/or less than 5% of calories from saturated fat. Two
researchers coded the machines together to ensure accu-
racy. Although it is recognized that these nutritional criteria
are not all encompassing, for example, sodium, fiber, and
sugar were not taken into account, the criteria do provide a
basis for selection categorization. Moreover, healthier fats
such as nuts were still given a red sticker because of the
high calorie count. This corresponds with the Nutrition

Environmental Measures Survey tool, which also places
nuts in the red category.
25
In addition to the colored sticker placed next to the food
item in the vending machine, a vinyl sticker approximately
8 by 12 inches was posted on the front panel of each vend-
ing machine, just above the selection button. The vinyl
sticker explained what the 3 color-coded stickers indicated
and gave the brief nutrition information about each colored
sticker. Finally, 11- by 14-inch posters developed by public
health students and the university marketing department
were placed around campus encouraging students to select
the green colored items with a slogan of “Go ahead, eat and
enjoy.” The yellow colored items stated “Caution, eat mod-
erately,” whereas the red color indicated “Stop, eat
sparingly.”
Once the educational materials were in place, the sales of
each item were then tracked for an additional 2 weeks. Dur-
ing this time frame, the number of red-, yellow-, and green-

coded items remained consistent. As the data were col-
lected, the number of sales for each food item was input
into an Excel spreadsheet.
Data Analysis
Data were analyzed using the Statistical Package for
Social Sciences (SPSS) version 19.0 for Windows (SPSS,
Chicago, Illinois). A paired-sample t test was used to mea-
sure sales in each of the 5 vending machines comparing
baseline sales to intervention sales. A paired-sample t test
determines differences in means and whether they are sig-
nificant.
26
A significant difference in means can indicate
Nutrition Education Intervention and Vending Machine Sales
VOL 62, OCTOBER 2014 513
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Brown, Flint, & Fuqua
514 JOURNAL OF AMERICAN COLLEGE HEALTH
that the intervention did have an influence on behaviors, in
this case the purchasing behaviors of college students

toward healthy and unhealthy food choices.
RESULTS
Table 1 shows descriptions of the categories of food
items, the machine numbers (M- nos.), and the baseline
sales compared with the intervention sales as well as the
percent change in total sales. The data show that some of
the items increased or decreased after the intervention,
depending on the machine and the item. For example, the
purchases of red-stickered foods in vending machine M2,
M3, and M5 were reduced. In addition, all of the machines
except M4 also had reduced sales of the yellow-labeled
food items. Moreover, the purchases for the green-labeled
items increased in all the machines following the interven-
tion. In total, there was a decrease in the sale of red-stick-
ered items of 113 (4.84%), as well as a decrease of 47
(15.21%) yellow-stickered items from baseline to after the
intervention. There was an increase in the sale of green-
stickered items of 235 (50.76%) from baseline to after the

intervention.
Results of the paired-sample t test analysis on the snack
items purchased before the intervention and after the inter-
vention demonstrated that there was one significant change
in consumer preferences after the intervention, p < .05,
with Cohen’s d effect size r D ¡.14 in machine M4, with
the green category items. Although there were large differ-
ences seen in the purchasing of certain items, there were no
significant differences in the purchases of the red and yel-
low category items across any of the 5 vending machines
after the intervention.
COMMENT
Accepting this study’s limitations, there are some impli-
cations for future research being done in this area. First,
more research is needed regarding the controlling of envi-
ronmental triggers, such as vending machines and their con-
tents, and what choices are made by individuals and/or
groups. The hypothesis that if all vending machines on col-

lege campuses only offered healthy foods then purchases
would dramatically decrease needs to be assessed through
well-controlled studies.
In addition, larger studies are needed that compare food
choices from not only more vending machines at one cam-
pus, but between multiple campuses. Further research is
needed that explores whether special events on campus
increase or decrease healthy or unhealthy food choices. In
the case of the current study, there were no special events
during the study’s time frame.
Limitations
Limitations of this study include a small sample size,
with only 5 vending machines on one university campus.
Although the study originally was designed to utilize 10
machines across campus with a longer intervention period,
restrictions from the university Dining Services made it
necessary to reduce the number of machines as well as the
intervention length.

Conclusions
The purpose of this study was to determine the impact of
a simple nutrition education intervention on the purchase of
healthy versus unhealthy food in vending machines on a
university campus. There is evidence that environmental
changes, such as offering a greater variety of healthier
foods and reducing the less healthy foods
17,27
as well as
pricing strategies such as lowering the price of healthier
items
28
and increasing the price of less healthy items,
20
can
have a positive effect on healthier vending machine
choices.
Although these interventions have proven effective in the
past, health professionals face challenges, especially if they
lack support from stakeholders. Early communication with

Dining Services, specifically vending staff, may have
resulted in a longer, more effective intervention. Also, fear
of reduced vending sales and lost revenue
8
may deter
schools and universities from participating in a healthy
vending program; however, this study demonstrated that
sales actually increased slightly during the intervention
period (total baseline sales were 3,105, whereas the total
intervention sales were 3,180). The total impact on sales
was an increase of 75 items (2.41%).
Public health strategies to create a “culture of health”
may be one piece to solving the epidemic of obesity. Pro-
viding a greater number of healthier options, providing ded-
icated machines with only healthy options, and utilizing
pricing strategies to encourage healthy selections were rec-
ommended to Dining Services. It is hoped that these types
of studies would encourage policy change on campus that
would foster healthier behaviors. Future studies should

examine both availability and pricing strategies to deter-
mine their effectiveness in a university setting. In addition,
the assignment of the color code may need to be adjusted to
accommodate healthier snacks (eg, almonds and other) that
may be higher in fat and calories.
FUNDING
This research was funded by the Grants for Engaged
Learning at Utah Valley University.
CONFLICT OF INTEREST DISCLOSURE
The authors have no conflicts of interest to report.
The authors confirm that the research presented in this
article met the ethical guidelines, including adherence to
the legal requirements, of the United States and received
approval from the Institutional Review Board of Utah
Valley University.
VOL 62, OCTOBER 2014 515
Nutrition Education Intervention and Vending Machine Sales

NOTE
For comments and further information, address corre-
spondence to Mary V. Brown, Utah Valley University,
Department of Public and Community Health, 800 W.
University Parkway, Orem, UT 84058, USA (e-mail:
[email protected]).
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Received: 18 March 2013
Revised: 10 March 2014
Accepted: 25 April 2014
516 JOURNAL OF AMERICAN COLLEGE HEALTH
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