Development Of A Healthy Vending Toolkit Final Write Up

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Healthy Vending Toolkit Project

By: Lusi M Martin

Project Period: January 2009 - March 2009

University of Tennessee Knoxville Department of Nutrition Community Nutrition II

Completed: April 20th, 2009

2 | H E A L T H Y V E N D I N G T O O L K I T P R O J E C T


Project Summary

The worksite offers a unique opportunity to develop behavioral and environmental strategies to improve health. A collaboration of the University of Tennessee Knoxville, Knox County Health Department (KCHD) and the East Tennessee Wellness Roundtable to develop and evaluate a Healthy Vending Toolkit for local area business managers was carried out. The Project Director is a graduate student in the Department of Nutrition at the University of Tennessee Knoxville, and was responsible for planning and developing the Healthy Vending Toolkit (Appendix A). The Co-Project Director is a Master’s level Registered Dietitian employed by KCHD. Currently, KCHD has implemented an environmental strategy through their New Knox County Vending Policy to increase the availability of healthier food items in vending machines, attempting to increase the consumption of healthier foods. The New Knox County Vending Policy has been developed to impact Knox County/City of Knoxville government offices. The development of the toolkit began January 16th, 2009 and officially was completed March 26th, 2009. Assessment surveys for worksite vending machines, employees and managers were developed using literature search and existing surveys. Surveys were built on SurveyMonkey and distributed via e-mail to approximately 200 managers and employees affiliated with the East Tennessee Wellness Roundtable. Surveys provided information on employee and manager perceptions of vending machines at the worksite. The surveys of manager and employee perception on worksite vending machines were used to tailor the Healthy Vending Toolkit for the intended population. Results from the manager and employee surveys revealed the following among others:

88.2% of worksites offer vending machines mainly for employees (93%). 92% of managers reported worksites not having a vending policy in place. 100% of managers were willing to implement healthy vending at the worksite 92% of employees would purchase healthy foods if made available 63% strongly agreed that they wanted healthy foods available 67% reported vending machines were not part of healthy environment

Additional findings are reported in the results section of this document. A final presentation of the Healthy Vending Machine content was held at the BB&T Bank located downtown Knoxville to the East Tennessee Wellness Roundtable Group. There were approximately 30 individuals present. Twenty three evaluations were collected after the presentation. All attendees reported the presentation providing information that was very useful (78%) or useful (22%) to implementing and sustaining healthy vending at the worksite. The surveys and evaluations collected from the stakeholders support the need for the Healthy Vending Toolkit. The Healthy Vending Toolkit will be available upon requests at the KCHD.


TABLE OF CONTENTS

Background 5 Problem Statement 7

Intended Population 7 Goals & Objectives 8 Methods 10 Results & Evaluation 12 Discussion & Recommendations 17 References 18 Appendices 19 Appendix A: Healthy Vending Toolkit Appendix B: Project/Co-Project E-mails Appendix C: Manager & Employee Assessment Survey Responses Appendix D: Worksite Vending Machine Survey Response Appendix E: Healthy Vending Toolkit Visual Presentation Appendix F: Presentation Evaluation Appendix G: Project Director Evaluation Appendix H: Key Activity Chart for Project Appendix I: Grant Proposal


BACKGROUND

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. can be attributed to changes in the environment that have influenced both eating and physical activity (2). Unfortunately, this rising trend in overweight and obesity have been predicted to continue both in adults and in children (3). 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 (4). 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 and cancer (5, 6, 7).

Major trends in the U.S. food environment may be 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 (2). In addition, these trends are the result of the frequent consumption of snack foods that are energy dense and contain poor nutrients. These foods are prepackaged and are usually considered convenient for an individual to consume/purchase immediately without much if any 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 reducing the availability of less healthy foods to individuals (8).

Healthy People 2010 Objectives have documented the need for worksite

interventions; an environment where there is a unique opportunity to improve employees health (8,9). 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 those individuals living in it to increase consumption. The worksite however, is a much smaller community that can be easily influenced and/or manipulated to assist individuals working in it to make healthier food choices. For example, vending machines at worksites could provide healthier food choices for individuals. However, it is important to note that when healthy foods (fruits, 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 (2). 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 (8) on the impact of nutrition environmental interventions on point of purchase behavior in adults found that worksites


where health information was provided at the time of purchase seemed to influence 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, creating an environment in which individuals would not have to actively choose healthier foods. This would be considered an environmental change (8). 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 this food item. Another study by French and colleagues (2001) 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 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. The University of Tennessee at Knoxville, Knox County Health Department (KCHD), and the East Tennessee Wellness Roundtable has partnered proposing to train area business managers on the implementation of healthier vending policies at their worksite. The KCHD and the University of Tennessee have a long history of collaborating on many projects including but not limited to conducting community assessment to determine needs. In addition, the KCHD is well-known in its support of many organizations in Knoxville including its support of the work performed by the East Tennessee Wellness Roundtable. The East Tennessee (ET) Wellness Roundtable is a fairly new organization established in 2006 by Gary Emig. At the time, Gary Emig was affiliated with Covenant Health and is now employed with Summitt Health where he continues to oversee the ET Wellness Roundtable. The ET Wellness Roundtable was created to help area employers start or understand how to generate interest in wellness programs. The Roundtable assists area employers find resources, give them the most current thoughts regarding wellness and guide them as they develop their wellness program at their worksites. Currently, the ET Wellness Roundtable has over 200 businesses in East Tennessee participating in its organization. Moreover, the KCHD took the lead in 2006, initiating a healthier vending machine system using a three-tiered color-coded system (Red, Yellow, and Green) for food 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 the presence of unhealthy food options. As a result, a new Knox County Vending Policy was established and has implemented 100% at the KCHD (Appendix A, Healthy Vending Toolkit p. 14). Healthy foods are identified by being a “smart snack”. In order to be a “smart snack”, foods must meet specific criterias. These criteria are made visible for all consumers on cling form sticker, and 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. The new Knox


County vending policy was established to impact vending machines for Knox County and City of Knoxville government offices. Unfortunately, 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.

Therefore, the objective of this project was to develop a healthy vending toolkit utilizing the New Knox County Vending Policy. The Healthy Vending Toolkit will be used to train area business managers to implement healthier vending policies at their worksite. The development process and evaluation of the healthy vending toolkit for area business managers was supported by the expertise of the Co-Project Director, a Master’s level Registered Dietitian employed by the KCHD. The Healthy Vending Toolkit was presented to the ET Wellness Roundtable Committee which has access to a large network of the East Tennessee area businesses. Collectively, the resources available at the KCHD, University of Tennessee, Knoxville, and ET Wellness Roundtable will help ensure the successful implementation of healthy vending machine policies in area businesses in Knoxville.

PROBLEM STATEMENT

Overweight and obesity remains an enormous public health concern for adults, and research has shown its contribution to the declining health status in the United States (9). The worksite offers a great opportunity for environmental change because managers have more control over of what foods can be available in vending machines, which in turn can result in a larger impact on healthier food choices.

INTENDED POPULATION The Healthy Vending Toolkit was developed to guide and support local area business managers in the implementation of healthy vending at their respective worksites.


GOAL AND OBJECTIVES

Goal: To increase the number of healthy vending policies being implemented at the worksites. Objective 1: By January 16th, 2009, the Project Director will meet with the Co-Project Director to discuss needs for healthy vending option at worksites in East Tennessee. Objective 2: By January 31st, 2009 the Project Director will develop 2 surveys; an Employee Survey Assessment and Manager Survey Assessment using literature and existing survey. 2.1: By January 23rd, 2009 the Project Director will develop a draft of a Survey of Worksite Vending Machines that will be sent to Co-Project Director for approval. 2.2: By January 23rd, 2009, the Project Director will develop a draft of a survey of Employee Assessment of Vending Machines that will be sent to Co-Project Director for approval. 2.3: By January 23rd, 2009, the Project Director will develop a draft of a survey of Manager Assessment of Vending Machines that will be sent to Co-Project Director for approval. 2.4: By January 31st, 2009, the Project Director will complete development of Employee Assessment of Vending Machines and Manager Assessment of Vending Machines surveys on SurveyMonkey website, and Worksite Vending Machines surveys on Microsoft Word.

2.5: By January 31st, 2009, the Project Director will send a link from Survey Monkey website of the Employee Assessment of Vending Machines and Manager Assessment of Vending Machines surveys to the Co-Project Director for delivery to ET Wellness Roundtable committee members via e-mail.

2.6: By February 1st, 2009, the Project Director will contact Co-Project Director to confirm that Employee Assessment of Vending Machines and Manger Assessment of Vending Machines surveys were distributed to the East Tennessee Wellness Roundtable committee members in order to collect their feedback on their respective worksite vending machines. Objective 3: By February 6th 2009, the Project Director will utilize developed Worksite Vending Machines survey to identify foods and beverages available to employees in vending machines at Knox County Health Department and the City County Building in Knoxville.


Objective 4: By February 20th 2009, the Project Director will analyze feedback from the Employee and Manager surveys on the SurveyMonkey website to generate a list of employees and managers perceptions of vending machines at worksites. Objective 5: By February 25rd, 2009, the Project Director will present survey results to the Co-Project Director to discuss feedback from the Employee and Manager surveys and worksite vending machine visits for the further development of the vending machine toolkit. Objective 6: By February 25rd, 2009, the Project Director will meet with Co-Project Director to identify strengths and weakness and/or progress thus far with the project. Objective 7: By March 13th, 2009 the Project Director will complete the final draft of the healthy vending toolkit which will be delivered to the Co-Project Director for approval. 7.1: By March 7th, 2009 the Project Director will complete a draft of the Healthy Vending Toolkit which will be delivered to the Co-Project Director for feedback and revisions. Objective 8: On March 26th, 2009, the Project Director will present the proposed Healthy Vending Toolkit to the East Tennessee Wellness Roundtable in order to establish a healthier eating environment at their respective worksite as determined by a training evaluation form completed by those present.


METHODS The major outcome of this project was the development of the Healthy Vending Toolkit for local distribution to worksite wellness managers. Regular contact between the Project Director and Co- Project Director were made through e-mail (Appendix B). The developmental process of the Health Vending Toolkit was divided into 5 phases as follows:

Phase 1: Initial meeting with Co-Project Director Phase 2: Development and Utilization of Surveys Phase 3: Data Collection and Interpretation Phase 4: Development & Presentation of Healthy Vending Toolkit Phase 5: Completion of Final Report to KCHD

PHASE 1: INITIAL MEETING WITH CO-PROJECT DIRECTOR The first phase of this project was defined by a face to face meeting with the Co-Project Director, an employee of the KCHD to discuss needs for healthy vending policies for the ET Wellness Roundtable Committee. In addition, the Co-Project Director provided background information on the healthy vending policy developed in 2006, as well as the New Healthy Vending System currently utilized by the KCHD, as a guide for the development of the Healthy Vending Toolkit. A quick tour of the vending machines at KCHD was carried out, and a brief discussion and update on the progress of the New Healthy Vending System in relation to foods offered at KCHD worksite vending machines. The meeting provided information needed to collect from the ET Wellness Roundtable Committee and a better understanding of the potential for healthy food choices in vending machines at worksites. PHASE 2: DEVELOPMENT & UTILIZATION OF SURVEYS The second phase of this project consisted of the development and utilization of three surveys: Employee Assessment Survey (EAS) (Appendix A, Healthy Vending Toolkit, p. 20), Manager Assessment Survey (MAS) (Appendix A, Healthy Vending Toolkit,p.18) and Worksite Vending Machine Survey (WVMS) (Appendix A, Healthy Vending Toolkit, p.23). The surveys were developed using literature and existing surveys. The Employee Assessment Survey included a total of 9 questions that gathered information on employee vending machine perceptions at the worksite. The Manager Assessment Survey consisted of a total of 10 questions that gathered information on the extent managers perceive and/or were willing to support the implementation of healthy vending policies, as well as perceived barriers to implementation. The Worksite Vending Machine Survey was used by the Project Director to assess food items at KCHD and the City Counsel Building in Knoxville vending machines to distinguish differences in food items available and the opportunity to improve food choices in vending machines. The Employee and Manager Assessment Surveys were set up online using SurveyMonkey with prior approval by the Co-Project Director. A link provided by SurveyMonkey with the EAS and MAS were distributed via e-mail to approximately 200


managers and employees affiliated with the ET Wellness Roundtable Committee to complete. PHASE 3: DATA COLLECTION & INTERPRETATION During phase three, data were collected and analyzed from the EAS and MAS by SurveyMonkey to determine perceived needs of vending machines. SurveyMonkey tracked the number of responses and quantified the percentages of individual responses to each question (Appendix C). A visual survey of a total of 4 snack vending machines and 4 beverage vending machines using the WVMS were conducted (4 from KCHD and 4 from City Counsel Building) was made to determine the number of healthy food items offered by each worksite vending machines (Appendix D). The two worksites were surveyed because both have implemented the New Healthy Vending Policy with the KCHD implementing 100% and the latter 30%. In addition, comments on the extent that vending machines followed the New Healthy Vending Policy in both facilities were observed and documented. All data from surveys were gathered and interpreted by the Project Director. A second face to face meeting was scheduled with the Co-Project Director at the KCHD to discuss the results of the three surveys found by the Project Director. PHASE 4: DEVELOPMENT & PRESENTATION OF HEALTHY VENDING TOOLKIT In phase 4, the Project Director developed the healthy vending toolkit using information from the surveys as well as information from numerous research articles as well as national organizations outside of the area who have successfully implemented healthy vending at their respective worksites. The final draft of the Healthy Vending Toolkit was approved by the Co-Project Director and presented using visual presentation to the ET Wellness Roundtable Committee on March 26th, 2009 (Appendix E). An evaluation form was provided to the presentation attendees to complete regarding the Healthy Vending Toolkit presentation (Appendix F). A final evaluation form was given to the Co-Project Director to evaluate the work carried out by the Project Director (Appendix G).

PHASE 5: COMPLETION OF FINAL REPORT TO KCHD In the final phase of the project, the Project Director prepared a draft of the final report. The final report provided results from the EAS, MAS, WVMS, evaluation forms, and Healthy Vending Toolkit.


RESULTS & EVALUATION The results are discussed based on attainment of the baseline objectives originally set for the healthy vending project. Please refer to Appendix H which provides a key activity chart; listing all key tasks carried out under each objective, along with a time frame, date of completion and evaluation of each tasks. Time frame and date of completion that did not occur before or at the time allotted is highlighted in yellow and justified in the appropriate section. In addition, refer to Appendix B which provides e-mail communications between Project and Co-Project Director for reference as appropriate. Each objective will be addressed in terms of completion and an evaluation will follow each objective. Objective 1: By January 16th, 2009, the Project Director will meet with Knox Co-Project Director to discuss needs for healthy vending option at worksites in East Tennessee. Project Director and Co Project Director successfully met as scheduled, January 16th, 2009. Both parties developed generated a lists of activities needed to be completed pertaining to the Healthy Vending project. The Co-Project Director provided the Project Director a list of the 2006 KCHD vending policy along with the revised version (aka the New Knox County Healthy Vending Policy) that is currently used by the KCHD. The Project Director met all deadlines for the mentioned objective. Objective 2: By January 31, 2009 the Project Director will develop 2 surveys; an Employee Survey Assessment and Manager Survey Assessment using literature and existing survey. Prior to the development of the Healthy Vending Toolkit, the Project Director dedicated the remaining month of January on researching existing literature on vending machine usage. Two surveys (EAS and MAS) were developed to gain information on the perception of healthy vending machines needs among stakeholders particularly managers and employees in the Knoxville Area. An additional survey of the vending machine environment was also developed (WVMS). Frequent communication between Project Director and Co-Project were carried out for feedback on the surveys. It took the Project Director longer than expected to review and finalize the survey questions due to scheduling conflicts. A final draft of all surveys was e-mailed to the Co-Project Director on January 28th, 2009; a week later than the original deadline. The survey links were disseminated to ET Wellness Roundtable Committee on January 30th, 2009; 9 days from the original deadline allowing the Co-Project Director one last final look before sending the surveys. (Appendix C) Objective 3: By February 6th 2009, the Project Director will utilize developed Worksite Vending Machines survey to identify foods and beverages available to employees in vending machines at Knox County Health Department and the City Council Building in Knoxville.


On February 6th, 2009, the Project Director met with the Co-Project Director at the KCHD to survey the KCHD Vending Machines. After surveying the KCHD vending machines, the Project and Co-Project Director went to the City Council Building about 4 miles from the KCHD and surveyed the vending machines located at that particular worksite. In comparing the two surveyed worksites in regards to food and beverages offered in vending machine, some key observations are worth commenting on. The first is that there is a clear distinction that the KCHD has implemented the New Healthy Vending Policy 100% through the types of foods offered in each vending machine. Regular soda was not offered in any of the beverage vending machines at the KCHD and the City Counsel Building differed demonstrating that the worksite has not fully implemented the vending policy proposed. In addition, foods offered in the vending machines at the KCHD consisted mainly of low fat items (baked chips), low sugar items (diet drinks, water) as well as healthy nuts (mixed nuts, granola). The City Counsel Building offered a variety of higher calorie, sugary, and fat foods (cinnabons, twinkies, regular chips, chocolate candy bars) (Appendix D). Objective 4: By February 20th 2009, the Project Director will analyze feedback from the Employee and Manager surveys on the SurveyMonkey website to generate a list of employees and managers perceptions of vending machines at worksites. Seventeen Manager Surveys and 24 Employee Surveys were completed online via Survey Monkey. The surveys provided valuable information pertaining to the perceptions of vending machines at the worksite. The lists below are the main findings from the surveys distributed to managers and employees affiliated with the ET Wellness Committee via Survey Monkey (Appendix C). Manager Surveys Results:

88.2% reported offering vending machines at the worksite There is inconsistency in who is responsible for vending machines at the worksites Healthier beverage choices are provided (60%) Healthier food choices are not provided (64%) Vending machines are for employees and not for the business or profit (93%) There is no existing vending policy at the workplace (92%) Managers are willing to provide and support healthy vending (100%). Specifically

offering lower calorie & sugary foods and beverages (100%) Main concern with implementing healthy vending is customer preference and sales

volume to support vendor stocking healthy items. Employee Survey Results: Reported vending machine were not part of healthy environment (67%) 92% would purchase healthy foods if made available 63% strongly agreed that they wanted healthy foods available Snack taste (75%), Hunger and fat content in a snack (54/2%), and how healthy a

snack is (50%) were very important in choosing snack foods at the vending machines (Table 1)


Amount of carbohydrates in a snack (62.5%), calories, value for money (50%), buying usual snack food (50%) and snack price (45.8) were somewhat important in choosing snack foods at the vending machines (Table 1)

Trying as snack I’ve never had before was reported not at all important (Table 1)

Category Not at all important

Somewhat important

Very important

Trying a snack I’ve never had before

87.5% 12.5% 0%

Snack Taste 0% 25% 75%

Snack Price 8.3% 45.8% 45.8%

Number of calories in snack 4.2% 50% 45.8%

Amount of fat in a snack 8.3% 37.5% 54.2%

Amount of Carbohydrates in a snack

16.7% 62.5% 20.8%

How healthy a snack is 12.5% 37.5% 50%

Watching my weight 12.5% 41.7% 45.8%

Value for my money 4.2% 50% 45.8%

Buying my usual snack 29.2% 50% 20.8%

How hungry I am 8.3% 37.5% 54.2%

Table 1: Influences on vending machine choices

Objective 5: By February 23rd, 2009, the Project Director will present survey results to the Co-Project Director to discuss feedback from the Employee and Manager surveys and worksite vending machine visits for the further development of the vending machine toolkit. On February 23rd, 2009, the Project Director and Co-Project Director held a meeting at 10:45am to discuss results from all the surveys used in the project. The major findings from the surveys discussed in the previous objective were discussed. Survey responses were used as a guide in developing the Healthy Vending Toolkit to tailor the targeted audience need for vending machines. Objective 6: By February 23rd, 2009, the Project Director will meet with Co-Project Director and UT Faculty Advisor to identify strengths and weakness and/or progress thus far with the project. On February 23rd, 2009 a meeting was held to discuss the healthy vending project and offer feedback to the Project Director. The Co-Project Director and UT Faculty Advisory both provided the Project Director with feedback to strengthen and enhance the project proposal. The meeting lasts about an hour and a copy of the draft of the proposal with


feedback was provided for the Project Director. The meeting was a success and valuable feedback was obtained both through verbal and written communication from UT Faculty Advisor and Co-Project Director. Objective 7: By March 13th, 2009 the Project Director will complete the final draft of the healthy vending toolkit which will be delivered to the Co-Project Director for approval. The Project Director used most of the month of February researching various worksite vending policies as a reference to the Healthy Vending Toolkit created in this project. A draft of the vending toolkit was sent to the Co-Project Director on the original deadline set; however the Co-Project Director was not able to turn the draft around in time for the Project Director to make the revisions to the toolkit on March 3rd, 2009 as determined originally. A follow-up e-mail about providing feedback on the draft of the toolkit was sent by the Project Director to the Co-Project Director March 11th, 2009. Feedback from the Co-Project Director was received March 12th, 2009. Revisions were made promptly by the Project Director and Healthy Vending Toolkit was finalized on time; March 13th, 2009 (Appendix B, H-I). Objective 8: On March 26th, 2009, the Project Director will present the proposed Healthy Vending Toolkit to the East Tennessee Wellness Roundtable as determined by the completion of a training evaluation form completed by those present. Beginning March 10th, 2009 the Project Director began to prepare a visual presentation for the ET Wellness Roundtable. The visual presentation was developed with the intended population being worksite managers (Appendix E). On March 26th, 2009, the Healthy Vending Toolkit project was presented at the BB&T bank in downtown Knoxville at 9am. The overarching message in the presentation was the increasing prevalence in overweight and obesity in has been a result of the changes in our environment over the past decades. Therefore, changes in smaller environments such as worksites are a stepping-stone as managers have more control over the types of foods that are in vending machines. Most importantly, the Healthy Vending Toolkit presented offers a step by step guide to planning, implementing and sustaining healthy vending policies in the workplace. Approximately 30 individual were present at the Healthy Vending Toolkit presentation. A short evaluation form was developed by the Project Director to determine appropriateness and usefulness of the information presented (Appendix F). A total of 23 evaluation forms were returned by individuals attending. All attendees reported the presentation providing information that was very useful (78%) or useful (22%) to implementing and sustaining healthy vending at the worksite. Reports also revealed 86% found the presentation to be very useful or useful in increasing willingness to implement healthy vending at the worksite. Seventy eight percent reported the information provided during the presentation increased their ability to implement healthy vending at the worksite.


Common themes from the open-ended questions revealed that the audience was alarmed of the obesity statistics in the state of Tennessee. All attendees who returned an evaluation form seem to mention how the Healthy Vending Toolkit presentation raised their awareness of the obesity epidemic and how there needs to be a change to improve health. Finally, the Co-Project Director evaluated the Project Director on various categories on a scale of 1(poor) – 5(outstanding). The Project Director was rated either good (3), above average (4) or outstanding (5) in every category (Appendix G).


DISCUSSIONS & RECOMMENDATIONS The main outcome of this project was to develop a vending toolkit to help guide and support local area business managers in their implementing and sustaining healthy vending at the worksite. A survey of the stakeholders revealed the need for healthy vending at the worksite. There has been a rapidly growing interest in the relation between changes in the environment and its effect on dietary intake as well as physiological outcomes such as weight (2, 8, 12, 13). With recognition that the overweight and obesity epidemic is a great concern as it is linked to many health diseases, health advocates have urged changes in various areas including the worksite environment (9, 10, 11). The Healthy Vending Toolkit developed in this project will offer interested parties with the tools needed to implement and sustain healthy vending. Evaluations from the stakeholders were very positive confirming the usefulness of the Healthy Vending Toolkit. Overall, the project allowed the Project Director to gain experience in developing a toolkit. The skills acquired in this project can be transferred on to other projects in the future. The strengths found in this project were the exposure to first hand collaborative work with outside agencies (e.g. KCHD), oral and written communications practice, budgeting practice & budgeting justification, organization of grant proposal, exposure to various methods of data collection and practice, basic data analysis and interpretation, presentation development, and responsibility. The following paragraph will discuss recommendations to improve the project experience. The first recommendation is to enhance skill and professional development through evaluation of both Project Director & Co-Project Director. This recommendation is based on the need for students to identify strengths and weaknesses early on in order to work on those skills and improve them accordingly. Evaluating the Co-Project Director will also allow students the opportunity in evaluating outside team members. The evaluation could include oral and written communication skills, punctuality, professionalism etc. The last recommendation is to encourage students to utilize previous projects conducted in the course as a guide to minimize confusion on what needs to be completed in their respective projects. Perhaps the faculty in charge of the classroom can bring to class a few examples of those completed assignments to show to students early on and directions on where those assignments could be found. To conclude, the project was a great exposure and opportunity to work with the community. The skills and experience gained from this project is part of the learning experience and professional development in the field.


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. Popkin BM., Duffey K., Gordon-Larsen P. Environmental influences on food choice, physical activity and energy balance. Physiol & Behav. 2005; 86: 603-613. 3. 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. 4. Tennessee Department of Health. Tennessee’s Behavioral Risk Factor Surveillance System 2007. In http://health.state.tn.us/statistics/brfss.htm, January 23, 2009. 5. 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 Trials. 2003; 24: 610-628. 6. American Cancer Society. In http://www.cancer.org/docroot/home/index.asp. January 23, 2009. 7. American Heart Association. In http://www.americanheart.org/presenter.jhtml?identifier=1200000, January 23, 2009. 8. 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. 9. 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. 10. Pratt CA, Lemon SC, Fernandez ID, Goetzel R, Beresford SA et al. Design Characteristics of Worksite Environmental Interventions for Obesity Prevention. Obes Rev. 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. 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.


Appendices

Development Of A Healthy Vending Toolkit Final Write Up

Business

healthy foods available

new knox county vending

project summary

employee surveys

surveys of manager

coproject director

assessment surveys

existing surveys