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 choices1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased healthy food purchases
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased healthy food consumption
Improved nutrition
Improved dietary choices
What does the research say about effectiveness?
There is strong evidence that healthy vending machine options increase sales of healthy foods and access to healthy foods in university settings2 and in workplaces and schools3, 4.
A study looking at healthy vending machine options in a large health organization found a reduction in number of calories, sodium, fat, and sugar sold through vending machines when healthy options were available5. Restricting the sale of sugar sweetened beverages has been shown to reduce consumption among high school students6 and kindergartners7. Increasing healthy options in vending machines may improve dietary behaviors6, 8, 9, especially when healthy options are made relatively less expensive than unhealthy options10. Price discounts for healthier foods have been shown to increase consumption of healthier foods8, 11, 12. Nutrition standards for vending machines and increased healthy vending options are suggested to improve nutrition13, 14, 15, 16, 17, 18.
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 graders19, 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 overweight20.
Vending machines generate significant revenue, particularly for schools. Some studies show no significant revenue losses from implementing vending machine policies in schools, workplaces, or hospitals21, 22, 23, 24, and possibly, a positive fiscal impact25, 26, 27. Other studies find data on revenue impacts too limited to adequately determine how changes in food options will affect school revenue28. A Los Angeles-based study indicates that effects can be neutral, positive, or negative depending on implementation29. Studies suggest that vending machines offering healthy options are feasible in hospital settings30, 31.
Successful healthy vending initiatives commonly include support from decision makers, internal and external partnerships with relevant experts, and clear communication between vendors and the community32. Contracts, a form of private regulation, may be a tool to help oversee healthy vending machine options33.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact increasing healthy vending machine options may have on disparities in the food environment, especially in schools and workplaces; in access to healthy food; and in overall diet and nutrition outcomes.
Many population groups in the U.S., especially people with low incomes and people of color, live and work in areas with an unhealthy food environment and have higher rates of food insecurity than people with higher incomes and white people40. These disparities in access to nutritious foods through both food environment and financial barriers contribute to disparities in diet quality40. Disparities in diet related health outcomes also persist by income level, race and ethnicity, education background, and geographic location in the U.S.41, 42.
What is the relevant historical background?
Throughout U.S. history, discriminatory housing, lending, and exclusionary zoning policies entrenched racial residential segregation and concentrated poverty43, 44. This systemic disinvestment and exclusion by both government and private entities created and maintains community environments with limited resources, deteriorating infrastructure, hazardous industries and waste disposal sites, and many other factors that lead to poorer health outcomes for people of color and people with low incomes45, 46, 47, 48. Communities shaped by discriminatory policies are often areas that have limited access to healthy and affordable food, formerly known as food deserts49, 50. Individuals who live in these communities face higher food costs, fewer store options, and must travel further to purchase healthy food than those who live in well-resourced communities49. Residents also have increased exposure to high calorie foods that have little nutritional value, which often leads to worse health outcomes50. Many rural areas also lack access to fresh and affordable food, even in areas where farming is an important part of the local economy51.
Vending machine sales began in the early 18th century in Britain and started in the U.S. in the late 1800s. Vending machines have distributed many goods, including tobacco products, gum, candy, cigarettes, soft drinks, snacks, and even prepared foods52. Vending machines can generate revenue and increase access to the goods they sell, since vending machines are available at all hours of the day and every day of the week. In recent decades, many public health organizations have advocated for increasing healthier options made available through vending machines. In 2019, the National Automatic Merchandising Association (NAMA) announced a new public health commitment to increase healthier options by 33% in their vending machines nationwide53.
Equity Considerations
- How many vending machines in your community offer healthy food and beverage options? What partnerships between community organizations, schools, workplaces, and public health advocates could support increasing healthier vending machine options locally?
- Which neighborhoods in your community have higher numbers of vending machines and more unhealthy food options available than healthy food options? Where can healthy vending machine options be implemented in your community?
- Who decides where vending machines will be placed in your community? Who decides what food items will be stocked in existing vending machines? In schools, libraries, community centers, etc.?
Implementation Examples
At the federal level, Smart Snacks in Schools was passed in 2014 and requires all foods sold at schools, including in vending machines, to meet specific nutrition standards34. In 2014, the U.S. Food and Drug Administration (FDA) also published a final rule declaring all operators owning or operating 20 or more vending machines must display calorie information for food and beverages sold from their machine35.
State initiatives supporting healthy vending machines are in Rhode Island36, Hawaii37, Alabama, Iowa, Mississippi, and Ohio38. Many localities also have healthy vending machine standards in their schools and public county buildings, for example, Chicago, IL39, Cameron County, TX; King County, WA; and several counties in California38.
Implementation Resources
‡ Resources with a focus on equity.
CDC-Working with vendors - Centers for Disease Control and Prevention (CDC). Work with vendors to improve accessibility of healthier foods.
CDC-Vending machine operation - Centers for Disease Control and Prevention (CDC). Behavioral design strategies for vending machine operation.
USDA-FNS wellness - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). Local school wellness policy.
WI DPI-LWP - Wisconsin Department of Public Instruction (WI 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.
UM-YES-Resources - University of Michigan (UM), 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
* Journal subscription may be required for access.
1 CDC-Vending machine operation - Centers for Disease Control and Prevention (CDC). Behavioral design strategies for vending machine operation.
2 Whatnall 2020 - Whatnall MC, Patterson AJ, Hutchesson MJ. Effectiveness of nutrition interventions in vending machines to encourage the purchase and consumption of healthier food and drinks in the university setting: A systematic review. Nutrients. 2020;12(3):876.
3 Pharis 2017 - Pharis ML, Colby L, Wagner A, Mallya G. Sales of healthy snacks and beverages following the implementation of healthy vending standards in City of Philadelphia vending machines. Public Health Nutrition. 2017;21(2):339-345.
4 Grech 2015 - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.
5 Grivois-Shah 2018 - Grivois-Shah R, Gonzalez JR, Khandekar SP, et al. Impact of healthy vending machine options in a large community health organization. American Journal of Health Promotion. 2018;32(6):1425-1430.
6 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.
7 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.
8 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.
9 French 2001 - French SA, Story M, Jeffrey RW. Environmental influences on eating and physical activity. Annual Review of Public Health. 2001;22:309-335.
10 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.
11 An 2013 - An, R. (2013). Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition, 16(7), 1215-1228.
12 AHA-Mozaffarian 2012 - Mozaffarian, D., Afshin, A., Benowitz, N.L., Bittner, V., Daniels, S.R., Franch, H.A., Jacobs, D.R., Kraus, W.E., Kris-Etherton, P.M., Krummel, D.A., Popkin, B.M., Whitsel, L.P., & Zakai, N.A. (2012). Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation, 126(12), 1514-1563.
13 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, D.C.: National Academies Press; 2009.
14 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.
15 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: U.S. Department of Health and Human Services (U.S. DHHS); 2011.
16 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):1624-1630.
17 Briefel 2009 - Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of U.S. public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S91-107.
18 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.
19 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.
20 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):437-444.
21 Griffiths 2020 - Griffiths ML, Powell E, Usher L, Boivin J, Bott L. The health benefits and cost-effectiveness of complete healthy vending. PLoS ONE. 2020;15(9):e0239483.
22 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):115-122.
23 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.
24 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):90-93.
25 Yan 2019 - Yan S, Pappas A, Yuan MD, Vafiadis D, Carson JA. Evaluating healthy vending at the American Heart Association National Center: A pilot study. American Journal of Health Promotion. 2019;33(6):928-932.
26 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.
27 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.
28 US GAO-Bellis 2005 - Bellis D. School meal programs: Competitive foods are widely available and generate substantial revenues for schools. Washington, D.C.: U.S. Government Accountability Office (U.S. GAO); 2005:GAO-05-563.
29 Wickramasekaran 2018 - Wickramasekaran RN, Robles B, Dewey G, Kuo T. Evaluating the potential health and revenue outcomes of a 100% healthy vending machine nutrition policy at a large agency in Los Angeles County, 2013-2015. Journal of Public Health Management and Practice. 2018;24(3):215-224.
30 Cradock 2022 - Cradock AL, Barrett JL, Daly JG, et al. Evaluation of efforts to reduce sodium and ensure access to healthier beverages in four healthcare settings in Massachusetts, U.S. 2016–2018. Preventive Medicine Reports. 2022;27:101788.
31 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.
32 Glanz 2018 - Glanz K, Bromberg J, Mirafzali Y, Green S. Evaluating healthy vending policies for youth in four cities. Philadelphia: University of Pennsylvania Prevention Research Center; 2018.
33 Dancey 2023 - Dancey J, Reeve B, Jones A, Brimblecombe J. The use of contracts as a form of private regulation to implement and manage healthy vending: Best practice recommendations for effective and sustained interventions. 2023.
34 USDA-FNS Focusing on smart snacks - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). Tools for schools: focusing on smart snacks.
35 USDA-FNS FDA requirement for vending machines - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). FDA requirements for vending machines.
36 CDC-Rhode Island - Centers for Disease Control and Prevention (CDC). Healthy vending in Rhode Island public school districts.
37 HI SDH-CHN - Hawaii State Department of Health (HI SDH). Choose healthy now (CHN) healthy vending project.
38 CDC-HVMI - Centers for Disease Control and Prevention (CDC). Healthier vending machine initiatives (HVMI) in state facilities.
39 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.
40 Kris-Etherton 2020 - Kris-Etherton PM, Petersen KS, Velarde G, et al. Barriers, opportunities, and challenges in addressing disparities in diet-related cardiovascular disease in the United States. Journal of the American Heart Association. 2020;9:e014433.
41 Brown 2022 - Brown AGM, Shi S, Adas S, et al. A decade of nutrition and health disparities research at NIH, 2010–2019. American Journal of Preventive Medicine. 2022;63(2):e49-e57.
42 Larson 2009 - Larson N, Story M. A review of environmental influences on food choices. Annals of Behavioral Medicine. 2009;38(1 Suppl):S56-73.
43 Zdenek 2017 - Zdenek RO, Walsh D. Navigating community development: Harnessing comparative advantages to create strategic partnerships. Chapter: The background and history of community development organizations. New York: Palgrave Macmillan; 2017.
44 Kaplan 2007 - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.
45 Braveman 2022 - Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic and structural racism: Definitions, examples, health damages, and approaches to dismantling. Health Affairs. 2022;41(2):171-178.
46 Prochnow 2022 - Prochnow T, Valdez D, Curran LS, et al. Multifaceted scoping review of Black/African American transportation and land use expert recommendations on activity-friendly routes to everyday destinations. Health Promotion Practice. 2022.
47 McAndrews 2022 - McAndrews C, Schneider RJ, Yang Y, et al. Toward a gender-inclusive Complete Streets movement. Journal of Planning Literature. 2022;38(1):3-18.
48 Brookings-Semmelroth 2020 - Semmelroth L. How Wilmington, Del. is revitalizing vacant land to rebuild community trust. Washington, D.C.: Brookings Institution; 2020.
49 Beaulac 2009 - Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966-2007. Preventing Chronic Disease. 2009;6(3):A105.
50 Walker 2010b - Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health and Place. 2010;16(5):876-884.
51 RHIhub-Rural food and hunger - Rural Health Information Hub (RHIhub). Rural hunger and access to healthy food.
52 Klein 2018 - Klein C. The automat: Birth of a fast food nation. History. 2018.
53 NAMA-Public health commitment - National Automatic Merchandising Association (NAMA), Convenience Services. Public health commitment.
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