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Healthy vending machine options

Evidence Rating

Some Evidence

Health Factors

There are a variety of mechanisms to increase healthy options in vending machines, including reducing the price of healthy choices and increasing the number of healthy choices compared to unhealthy choices. 

Expected Beneficial Outcomes (Rated)

  • Improved dietary choices

Other Potential Beneficial Outcomes

  • Increased healthy food consumption

  • Improved nutrition

Evidence of Effectiveness

There is some evidence that increasing healthy options in vending machines improves dietary behaviors (, Cradock 2011, ), especially when healthy options are made relatively less expensive than unhealthy options (French 2010). Price discounts for healthier foods have been shown to increase consumption of healthier foods (, , AHA-Mozaffarian 2012). Vending machine nutrition standards and increased healthy vending options are suggested strategies to improve nutrition (, CDC-Make a differenceCDC-Fruits and vegetables 2011, , , Kubik 2003, ). Additional evidence, especially studies focused solely on vending machines, is needed to confirm effects. 

Restricting the sale of sugar sweetened beverages has been shown to reduce consumption among high school students (Cradock 2011) and kindergartners (). Young people suggest that increasing healthy options in vending machines may facilitate improvements in their eating (EPPI-Shepherd 2001).

Competitive food availability through vending machines, snack bars, or à la carte, is not associated with adolescent weight gain in one study of 5th to 8th graders (Van Hook 2012), suggesting that systemic changes to the broader food environment may be needed to substantially reduce weight gain. States with strong laws governing competitive food nutrition content across grade levels, including vending machine food choices, appear to reduce adolescent body mass index (BMI) increases and the likelihood of adolescents remaining overweight (Taber 2012).

Vending machines generate significant revenue, particularly for schools. Some studies show no net fiscal effect from changing vending machine policies in schools and workplaces (, , ), and possibly, a positive fiscal impact (Fox 2005a, Lessard 2014). Other studies find data on revenue impacts too limited to adequately determine how changes in food options will affect school revenue (US GAO-Bellis 2005).

One study suggests that vending machines offering healthy options are also feasible in hospital settings ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

As of 2008, vending machines were available in 17%, 82%, and 97% of elementary, middle, and high schools respectively (Finkelstein 2008). State initiatives supporting healthy vending machines are in Rhode Island (CDC-Rhode Island), Hawaii (HI SDH-CHN), Alabama, Iowa, Mississippi, and Ohio (CDC-HVMI). Many localities also have healthy vending machine standards in their schools and public county buildings, for example, Chicago, IL (Suarez-Balcazar 2007), Cameron County, TX; King County, WA; and several counties in California (CDC-HVMI). A study of Chicago Public Schools illustrates some challenges and successes from efforts to improve vending machine options (Suarez-Balcazar 2007).

Implementation Resources

ChangeLab-Healthy vending - ChangeLab Solutions. Healthy vending machines.

USDA-FNS wellness - US Department of Agriculture (USDA), Food and Nutrition Service (FNS). Local school wellness policy.

WI DPI-School wellness - Wisconsin Department of Public Instruction (DPI). School wellness policy.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014.

YES!-Toolkits - Youth Empowered Solutions (YES!). Toolkits and resources.

CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities.

HOST-Healthy eating - Healthy Out-of-School Time (HOST) Coalition. Resources: Healthy eating.

Citations - Evidence

* Journal subscription may be required for access.

French 2001* - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309–35.

Story 2008* - Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health. 2008;29:253-72.

IOM-Government obesity prevention 2009* - Institute of Medicine (IOM), National Research Council (NRC), Committee on Childhood Obesity Prevention Actions for Local Governments. Local government actions to prevent childhood obesity. (Parker L, Burns AC, Sanchez E, eds.). Washington, DC: National Academies Press; 2009.

Cradock 2011 - Cradock AL, McHugh A, Mont-Ferguson H, et al. Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006. Preventing Chronic Disease. 2011;8(4):A74.

Fernandes 2008* - Fernandes MM. The effect of soft drink availability in elementary schools on consumption. Journal of the American Dietetic Association. 2008;108(9):1445-52.

Fox 2005a - Fox S, Meinen A, Pesik M, Landis M, Remington PL. Competitive food initiatives in schools and overweight in children: A review of the evidence. Wisconsin Medical Journal. 2005;104(5):38-43.

Briefel 2009* - Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of US public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S91-107.

CDC-Make a difference - Centers for Disease Control and Prevention (CDC). Make a difference at your school! CDC resources can help you implement strategies to prevent obesity among children and adolescents. Atlanta: Centers for Disease Control and Prevention (CDC); 2008.

Wiecha 2006* - Wiecha JL, Finkelstein D, Troped PJ, Fragala M, Peterson KE. School vending machine use and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth. Journal of the American Dietetic Association. 2006;106(10):1624-30.

Kubik 2003 - Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M. The association of the school food environment with dietary behaviors of young adolescents. American Journal of Public Health. 2003;93(7):1168-73.

EPPI-Shepherd 2001 - Shepherd J, Harden A, Rees R, et al. Young people and healthy eating: A systematic review of research on barriers and facilitators. London, UK: Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit (SSRU), Institute of Education, University of London; 2001.

Wharton 2008* - Wharton CM, Long M, Schwartz MB. Changing nutrition standards in schools: The emerging impact on school revenue. Journal of School Health. 2008;78(5):245-51.

Fiske 2004* - Fiske A, Cullen KW. Effects of promotional materials on vending sales of low-fat items in teachers’ lounges. Journal of the American Dietetic Association. 2004;104(1):90-3.

US GAO-Bellis 2005 - Bellis D. School meal programs: Competitive foods are widely available and generate substantial revenues for schools. Washington, DC: US Government Accountability Office (US GAO);2005: GAO-05-563.

Taber 2012 - Taber DR, Chriqui JF, Perna FM, Powell LM, Chaloupka FJ. Weight status among adolescents in States that govern competitive food nutrition content. Pediatrics. 2012;130(3):437–44.

Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. Journal of School Health. 2012;82(3):115–22.

An 2013* - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-28.

Van Hook 2012 - Van Hook J, Altman CE. Competitive food sales in schools and childhood obesity: A longitudinal study. Sociology of Education. 2012;85(1):23–39.

CDC-Fruits and vegetables 2011 - Centers for Disease Control and Prevention (CDC). Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to increase the consumption of fruits and vegetables. Atlanta: US Department of Health and Human Services (US DHHS); 2011.

Van Hulst 2013* - Van Hulst A, Barnett TA, Dervy V, Cote G, Colin C. Health-promoting vending machines: Evaluation of a pediatric hospital intervention. Canadian Journal of Dietetic Practice and Research. 2013;74(1):28-34.

French 2010 - French SA, Hannan PJ, Harnack LJ, et al. Pricing and availability intervention in vending machines at four bus garages. Journal of Occupational and Environmental Medicine. 2010;52(Suppl 1):S29-33.

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63.

Alaimo 2013* - Alaimo K, Oleksyk SC, Drzal NB, et al. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children’s diets. Childhood obesity. 2013;9(6):509-523.

Lessard 2014 - Lessard L, Poland M, Trotter M. Lessons learned from a healthful vending pilot program in Delaware state agency buildings, 2011-2012. Preventing Chronic Disease. 2014;11(140188):1-8.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC-Rhode Island - Centers for Disease Control and Prevention (CDC). Healthy vending in Rhode Island public school districts.

Suarez-Balcazar 2007 - Suarez-Balcazar Y, Redmond L, Kouba J, et al. Introducing systems change in the schools: The case of school luncheons and vending machines. American Journal of Community Psychology. 2007;39(3-4):335-45.

Finkelstein 2008 - Finkelstein DM, Hill EL, Whitaker RC. School food environments and policies in US public schools. Pediatrics. 2008;122(1):e251-9.

CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities.

HI SDH-CHN - Hawaii State Department of Health (HI SDH). Choose healthy now (CHN) healthy vending project.

Date Last Updated

Oct 21, 2015