Healthy vending machine options
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.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved dietary choices
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased healthy food consumption
Improved nutrition
What does the research say about effectiveness? This strategy is rated some evidence.
There is some evidence that increasing healthy options in vending machines improves dietary behaviors1, 2, 3, especially when healthy options are made relatively less expensive than unhealthy options4. Price discounts for healthier foods have been shown to increase consumption of healthier foods1, 5, 6. Vending machine nutrition standards and increased healthy vending options are suggested strategies to improve nutrition7, 8, 9, 10, 11, 12, 13. 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 students2 and kindergartners14. Young people suggest that increasing healthy options in vending machines may facilitate improvements in their eating15.
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 graders16, 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 overweight17.
Vending machines generate significant revenue, particularly for schools. Some studies show no net fiscal effect from changing vending machine policies in schools and workplaces18, 19, 20, and possibly, a positive fiscal impact21, 22. Other studies find data on revenue impacts too limited to adequately determine how changes in food options will affect school revenue23.
One study suggests that vending machines offering healthy options are also feasible in hospital settings24.
How could this strategy impact health disparities? This strategy is rated 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 respectively25. State initiatives supporting healthy vending machines are in Rhode Island26, Hawaii27, Alabama, Iowa, Mississippi, and Ohio28. Many localities also have healthy vending machine standards in their schools and public county buildings, for example, Chicago, IL29, Cameron County, TX; King County, WA; and several counties in California28. A study of Chicago Public Schools illustrates some challenges and successes from efforts to improve vending machine options29.
Implementation Resources
USDA-FNS wellness - US Department of Agriculture (USDA), Food and Nutrition Service (FNS). Local school wellness policy.
WI DPI-LWP - Wisconsin Department of Public Instruction (DPI). Local wellness policy (LWP).
LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.
YES-Resources - University of Michigan, School of Public Health. Youth Empowered Solutions (YES). 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.
Footnotes
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1 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.
2 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.
3 French 2001 - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309-35.
4 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.
5 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.
6 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):1514-1563.
7 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.
8 CDC-Keener 2009 - Keener D, Goodman K, Lowry A, et al. Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Centers for Disease Control and Prevention (CDC); 2009.
9 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.
10 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.
11 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.
12 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.
13 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.
14 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.
15 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.
16 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.
17 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.
18 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.
19 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.
20 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.
21 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.
22 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.
23 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.
24 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.
25 Finkelstein 2008 - Finkelstein DM, Hill EL, Whitaker RC. School food environments and policies in US public schools. Pediatrics. 2008;122(1):e251-9.
26 CDC-Rhode Island - Centers for Disease Control and Prevention (CDC). Healthy vending in Rhode Island public school districts.
27 HI SDH-CHN - Hawaii State Department of Health (HI SDH). Choose healthy now (CHN) healthy vending project.
28 CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities.
29 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.
Related What Works for Health Strategies
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