Healthy Vending Toolkit For Worksites Presentation

4/5/2009

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U N I V E R S I T Y O F T E N N E S S E E K N O X V I L L E

D E P A R T M E N T O F N U T R I T I O N

Healthy Vending Toolkit for Worksites

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Lusi Martin: Public Health Nutrition Graduate Student

Preceptor: Sarah Fisher, RD, MS-MPH

Overview

Introduction

Why do we want Healthy Vending at worksites?

Literature Review

Survey

Knox County Healthy Vending Policy

7 Steps for Healthy Vending at the Worksite

Conclusion

Questions/Discussion

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Introduction

Overweight and obesity continues to be a public health problem1

Building Healthier Worksites2,3

Vending Machines are part of worksite eating environment

Development of the Healthy Vending Toolkit for Worksites will assists managers to make transitions easier and sustainable

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Why do we want Healthy Vending at worksites?

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Overweight & Obesity Problem

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Overweight & Obesity is Costly:

• Social

• Physical

• Psychological

• Financial

“Healthier workers are more productive”

1996

1991

Obesity Trends* Among U.S. Adults4

BRFSS, 1990, 1991, 1996, 1998, 2004

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2004

Source: Behavioral Risk Factor Surveillance System (BRFSS), CDC

1990

1998

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Obesity Trends* Among U.S. Adults4

BRFSS, 2007

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2007

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: Behavioral Risk Factor Surveillance System, (BRFSS) CDC 7

BRFSS, 2006 & 20075

United States

2006 – 61%

2007 – 63%

Tennessee

2006 - 58%

2007 - 67%

We are concern with the rise in overweight in obesity as it is linked to many chronic diseases including:

•Heart Disease•Type 2 Diabetes •Cancers

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Changing Environment6

Overweight and Obesity has been attributed to changes in our environment that has influenced both eating and activity

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Availability of Food6

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Total caloric intake has increased among all races, ages, socioeconomic backgrounds and genders6

Frequent consumption of snack foods that are energy dense and contain few nutrients6

Inadequate physical activity6

Targeting environmental and policy interventions to achieve a change in dietary and activity pattern is encouraged6,7

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Healthy People 2010 Objectives3

National Heart Lung and Blood Institute (NHLBI) have funded 7 studies focusing on obesity prevention in 114 worksites with about 48,000 employees8

The worksite environment in particular has been viewed as an environment that offers a unique opportunity to promote healthy changes among individuals3,8

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Literature Review

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Healthy Employees are More Productive Employees9

Population: The heart healthy labeling program was institutionalized in all worksites serviced by Maumee Valley Vending.

Objective(s): Henry County Heart Health Coalition in Ohio and Maumee Valley Vending, Inc. collaborated to determine whether a 5 a Day labeling program on vending machines would increase consumption of heart healthy foods by worksites employees.

Methods: Cold machine items were labeled with a heart healthy or 5 a Day sticker as they came off the production line. In snack machines, ―Healthy Vending Choices‖ static clings were placed on the front glass of machines to assist customers with selections, and beverage machines promoted healthy items through educational information

Findings: An evaluation from March through September 2003 indicated an 80% increase in the sale of heart healthy items and a 14 percent increase in 5 a Day items. Survey indicated that 100 percent of the companies believed that having access to healthy food choices in vending machines is beneficial and 57% of employees used the program to identify Heart Health and/or 5 a Day foods to purchase.

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Pricing and promotion effects on low-fat vending snacks purchases: The CHIPS Study10

Population: Adults & Children, Schools and Worksites

Objective(s): To examine the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines.

Methods: Low-fat snack items were added to 55 vending machines at 12 secondary schools and 12 worksites. There were four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction). There were also 3 promotional conditions (none, low-fat label, low-fat label + promotional sign). Sales of low-fat items were tracked continuously for 12 months.

Findings: Price reductions at all levels (10%, 25%, 50%) were associated with significant increases in sales of low-fat snacks (9%, 39%, 93% respectively). Promotional signage was weakly associated with increases in low-fat snack sales. Pricing and promotion had similar effects on adolescent and adult population.

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Effect of promotional materials on vending machines sales of low-fat items in teacher’s lounges11

Populations: Adults/schools/Teachers

Objective(s): To examine the impact of and environmental intervention using promotional materials and increasing the availability of low-fat items on vending machine sales.

Methods: Ten vending machines located at elementary or middle school teacher’s lounges were randomly assigned to 1 of 3 conditions; control, and one of two experimental conditions. Low fat items were promoted in two ways: labeling (intervention I) and labeling + signage (intervention II). Total number of items sold and total revenue was recorded weekly for 4 weeks.

Findings: An increase in the number of low-fat items sold were seen from the vending machines sold at intervention level II. Sales revenue was not reduced as a result of the increased selection of low-fat items.

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Survey Results

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Employee and Manager surveys were distributed via e-mail to individuals affiliated with the East Tennessee Wellness Roundtable

17 Managers Surveys were completed

24 Employee Surveys were completed

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Manager Survey Employee Survey

Inconsistency in who is responsible for vending machines

Healthier beverage choices are provided (60%)

Healthier food choices are not provided (64%)

Vending machines are for employees(93%)

No vending policy (92%)

Willing to provide and support healthy vending (100%)

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

Survey Results19

Not at all important

Somewhat important

Very important

Trying a snack I’ve never had before 87.5%

Snack Taste 75%

Amount of fat in snackHow hungry I am

54.2%

How healthy a snack is 50%

Snack priceWatching my weight

45.8%

Value for my moneyNumber of calories in snackBuying my usual snack

50%

Amount of Carbohydrate 62.5%

Employee Survey Results20

Knox County Healthy Vending Policy

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Background on Vending Policy

In 2006, the Knox County Health Department initiated a health vending system using a three-tiered color coded system

Red (not healthy)

Yellow (somewhat healthy)

Green (the healthiest)

• The three-tiered color-coded system allowed 30% implementation of healthy vending.

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New Knox County Healthy Vending Policy

Healthy foods are identified as a ―smart snack‖

In order to be a ―smart snack‖, foods must meet specific criteria

These criteria are made visible for all consumers on a cling form sticker posted on the outside of each vending machine

In addition, a ―smart snack‖ apple sticker is used to identify each vending product meeting ―smart snack‖ criteria

This system has allowed for 100% implementation

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Snack Smart Criteria

―Smart Snack‖ criteria for vending products are as follows:

5 grams or less of total fat

2 grams or less of saturated fat

30 grams or less of sugar

Nuts and seeds are exempt

100% Juices are exempt

Vending products meeting ―Smart Snack‖ criteria will be marked with apple sticker by selection #.

Cling form sticker with ―Smart Snack‖ information will be placed on outside of vending machines.

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Criteria Rationale Example of Foods/beverages

5g or less of total fat High amounts associated with higher calorie foods and saturated fat intake

Healthy SnacksBaked chipsAnimal CrackersGraham CrackersPretzelsNuts and seeds (plain & with spices)Trail mix (plain)Dried fruit (raisins, dried cranberries, or other fruit)Fruit SnacksFat-free popcornYogurtGranola/cereal barsLow fat cookies

BeveragesJuice- fruit or vegetableWater (plain or flavored)Diet sodas (coke zero etc.)

2g or less of saturated fat High amounts associated with elevated blood lipids (cholesterol, triglycerides, LDL, low HDL) which can lead to heart disease

30g or less of sugar Add calories w/no nutrient

Nuts and seeds are exempt

Nuts and seeds contain heart healthy fats

100% juice are exempt 100% juice contains no added sweeteners; contributes to the recommended 5-A-Day

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7 Steps for Healthy Vending at the Worksite

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I. POLICY DEVELOPMENT AND PLANNING

Step 1: Develop a Wellness Committee: Representatives from various groups/departments

Have an interests in promoting health at the worksite

Meet regularly to discuss timeline for implementing the policy

Have a public health nutritionists present to offer advice as needed

• Step 2: Develop a Logic Model:

A logic model is a ―simplified picture of a program, initiative, or intervention that shows the logical relationship among the resources that are invested, the activities that take place, and the benefits of changes that result- a roadmap‖

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Example of Logic Model

Step 3: Use KCHD Healthy Vending Policy Guidelines or develop your own worksite guidelines

Step 4: Identify opportunities and possible threats early on, and then brainstorm ideas to capitalize on opportunities and problem solve threats

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II. Assessment

Step 5: In order to develop and implement your Healthy Vending Policy successfully, the following must be assessed

Manager Assessment Survey

Employee Assessment Survey

Food Selection Survey

Vending Machine Assessment Survey

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III. Implementation

Step 6: Communication is the key in ensuring the successful implementation of your vending policy.

A. Vendors:

• Letters to vendors,

• Attach healthy food lists,

• Ask vendors to strategically price & place healthy foods where they will more likely be purchased.

B. Vending Machine Users:

• Promote healthy foods through newsletters and on-site education.

• Use labels on vending machine.

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IV. Monitoring & Evaluation

Step 7: Periodic process monitoring and evaluation is crucial in ensuring that you are obtaining regular feedback on how your healthy vending policy is working at the worksite

Vending Machine Survey

Evaluation Survey for Vending Machine Users

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5 Key Elements for Creating a Successful Vending Policy

1. HAVE AN ELECTED “CHAMPION”

a) Why? Champion will see it through the politics.

b) A champion can be found or made—prior interest in public health, nutrition helps!

c) Be armed with the information about why this is relevant to obesity issue.

2. WORK CLOSELY WITH PUBLIC HEALTH EXPERTS AND LEADERSHIP

a) From county health department, or universities

b) Create an inventory of current policy or lack thereof:

• Is anyone in charge now?

• Who regulates or has any jurisdiction, or could?

• Make sure those folks are at the table.

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3. MAKE THE POLICY REASONABLE

a) Know your priorities early and make sure your champion shares them.

b) Understand that the policy process contains many compromises.

c) Ask yourself:

• What is our ultimate goal?

• What are we willing to fight for?

• What is realistic?

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4. MAKE THE POLICY ENFORCEABLE

a) Get all administrators at the table early; keep policy reality-based.

b) Put someone in charge to be held accountable.

c) Have deadlines/timelines for implementation and enforcement.

d) Include regular reporting to authorizing agencies (Board of Sups, etc) to

keep it on the radar.

5. HAVE YOUR VENDING POLICY BE MORE THAN AN END— USE IT AS A MEANS/OPPORTUNITY FOR EDUCATION

a) Puts obesity and nutritional health on radar for elected representatives.

b) Follow up and pick a new goal.

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Conclusion

The Healthy Vending Toolkit is a starting point to improving health at worksites

It provides general information and tools that can easily be used to transform vending machines at your worksite

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References

1. AAllender S., & Rayner M. The burden of overweight and obesity-related ill health in the UK. Obesity Reviews. 2007; 8:

467-4732. Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan LK. Impact of nutrition environmental interventions on point of purchase behavior in adults: a review. Preventive Medicine. 2004; 39: S108 – S136.3. 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.

4. Behavioral Risk Factor Surveillance System (BRFSS). Retrieved from http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm. Accessed March 23, 2009.5. Tennessee Department of Health. Tennessee’s Behavioral Risk Factor Surveillance System 2007. Accessed January 23 ,

2009 from http://health.state.tn.us/statistics/brfss.htm.6. Popkin BM., Duffey K., Gordon-Larsen P. Enviornmental influences on food choice, physical activity and energy

balance. Physiology & Behavior. 2005; 86: 603-6137. Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan LK. Impact of nutrition environmental interventions on point of purchase behavior in adults: a review. Preventive Medicine. 2004; 39: S108 – S136.8. Pratt CA, Lemon SC, Fernandez ID, Goetzel R, Beresford SA et al. Design Characteristics of Worksite Environmental Interventions for Obesity Prevention. Obesity Review. 2007; 15: 2171 – 2180.

9. Kille B. Healthy employees are more productive employees. Presentation delievered at Great Lakes Regional Cardiovascular Health Conference, 2003.10. French SA, Jeffery RW, Story M, Breitlow, Baxter JS et al. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS study. American Journal of Public Health. 2001; 91: 112 – 117.11. Fiske A, Cullen K. Effects of promotional materials on vending sales of low-fat items in teachers’ lounges. Journal of the

American Dietetic Association. 2004; 90-93.

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