State of Wellness Healthy Vending Programs

HEALTHY VENDING MACHINE PROJECT

Nutrition Environment Measures Survey Vending - NEMS-V

Developed to assess workplace vending machines

Based on the Institute of Medicine’s (IOM) nutrition standards for schools

Intended to have an easy to use coding system: red, yellow and green

NEMS-V: Development & Pilot-testing

Developed by Susan Klein of Iowa State University Extension and Carol Voss of the Iowa Department of Public Health

Funding provided by the Wellmark Foundation Consulted with NEMS staff - Karen Glanz, PhD, MPH

and Margaret Clawson, MPH, UPenn $500 mini-grants provided to 11 communities in May

2010 to complete assessments, report findings to coalition or wellness committee, and determine next steps

$1,000 mini-grants awarded in spring 2011 – 6 focused on vending

Reliability testing completed in September, 2011

NEMS-V Coding

RED food and beverages are not as healthy and fall outside the Dietary Guidelines for Americans. 

YELLOW food and beverages are healthy foods that meet the Dietary Guidelines, but do not provide a serving of fruit, vegetable, low-fat dairy or whole grain. 

GREEN food and beverages are considered the healthiest, are consistent with the Dietary Guidelines for Americans and provide a serving of fruit, vegetable, low-fat dairy or whole grain. 

A healthy choice calculator is available on website if one can’t figure out if the product is coded red, yellow or green.

NEMS-V Coding

Green Food Criteria

Green - Provides at least one serving of fruit, vegetable, and/or whole grains or non-fat/low-fat dairy products and meets the Dietary Guidelines for Americans.

Must also meet all of the following criteria:• ≤200 calories per portion as packaged • No more than 35 percent of total calories from fat • <10 percent of total calories from saturated fat • Zero trans fat (less than or equal to 0.5 grams per

serving • ≤35 percent of calories from total sugars, except for

yogurt with no more than 30 grams of total sugars, per 8 oz portion as packaged

• Sodium content of 400 mg or less per portion as packaged

Yellow & Red Food Criteria

Yellow – Criteria is the same as Green, but does not provide at least one serving of fruit, vegetable, and/or whole grains or non-fat/low-fat dairy products, but also does meet the Dietary Guidelines for Americans.

Red - Does not meet green or yellow criteria.

Vending Location Cover Page: 9 questions about worksite and vending machines (who stocks, gets profit, etc.)

Individual Machine Cover Page: 9 questions related to the machine (type of machine, location, accessibility, etc.)

Individual Machine Graphic: Tracks the number and products to record for each machine.

Food & Beverage Recording Sheet: record each item, size, price, category of beverage, fruit/vegetable/refrigerated, salty, sweet, ns entrees/sandwiches, and its NEMS-V code.

NEMS-V Tool

NEMS-V Website

www.nems-v.com Website intended to guide an employee of a

company through all of the steps from the initial assessment to how to go about changing some of the products in the machines.

Tips and guidance are offered on how to communicate with a vendor (the stocker of the machine) and renegotiate the contract.

Success stories are highlighted.

NEMS-V Website Features

NEMS-V Tools Tutorial: 15 minute online demonstration on how to complete a NEMS-V assessment

NEMS-V Healthy Choices Calculator Tutorial: 5 minute online demonstration on how to use the Healthy Choices Calculator to determine green, yellow, or red food/beverage choices

Ready to complete graphic for displaying vend #, color code and/or calories for each machine

NEMS-V Website Features

Provides an award certificate for each machine and the location Bronze award - if at least 30% of the food or

beverage choice are yellow or green; Silver award if at least 40% are yellow or green; Gold award if at least 50% are yellow or green and

without unhealthy advertising Generates a report card for each machine and location

Indicates how many food and beverage items need to be changed to green or yellow choices to earn a Bronze, Silver or Gold award

Provides a checklist of action steps for making healthier choices available in vending machines

Reliability Testing

Results demonstrate that the website tutorial can be an effecting teaching tool and that the NEMS-V assessment tool is reliable.

•There was high percentage of agreement for both product and color between rater groups (A versus B) and time (time 1 versus time 2).

•While both product and color agreements have reliable results; the product agreement is relatively higher than the color agreement.

Mini Grant Worksite Successes Four projects focused on buildings that

house county employees and non-profit organizations. NEMS-V assessments in 13 buildings with 46 vending machines.

Two projects focused on businesses in four different counties, completing 132 NEMS-V assessments in 16 businesses.

The State Employee Wellness committee used funds to pilot a produce cart in three State office buildings.

Success StoryNEMS-V was used to survey vending machineslocated in Dallas County buildings. Dallas County house 6 vending machines, including 4beverage and 2 snack. The assessment showed there were no yellow or green snack foods. The Sherriff’s office is responsible for filling the machines. A resolution was passed in December, 2011, by the Board of supervisors stating that food and beverages sold in vending machines on Dallas County property will offer a minimum of 30% healthier choices as determined by the NEMS-V. guidelines.

Similar resolutions are currently being drafted for Linn and Scott Counties.

Dallas County, Iowa

Next Steps for NEMS-V

Social marketing planning process to motivate individuals to make healthy choices in the vending machines Conduct interviews at worksites Online focus groups Message development Testing

Focus Group Findings

White Collar Employees were very likely to say they paid attention to nutrition labels with 19 of 24 (79%) in the respondent sample saying they looked at labels at least some of the time.

 White collar respondents were more often “rationalizing” their snack indulgences, either because it was the “wiggle room” in their overall approach to eating or because they exercised regularly which allowed for their indulgences.

Focus Group Findings (cont.)

Many respondents seemed to give themselves permission to ignore everything they know about nutrition and just pick “junk”. Others visit the vending area with very low expectations for nutritious offerings, leaving empty-handed or generally avoiding the vending machines altogether.

Respondents said “sometimes you just NEED CHOCOLATE!” One of the most frequently selected snacks and most ardently defended was chocolate – Snickers and M&M’s were popular in this category.

Nearly 6 in 10 respondents thought message worked best to communicate the snack rating system clearly.

Respondents liked that it illustrated examples of foods, which made the color coding system very clear.

The main message was focused on encouraging people to choose better snacks at least some of the time.

Many noted they had never seen vending machines with healthy options stocked in them.

Message Selected

Sustaining Healthy Vending

Project will lead to having a policy in place for state facilities to provide a minimum of 30% of food and beverage choices in vending machines as healthy options based on NEMS-V criteria

Project will serve as a model for other businesses across the state.

Insights from Iowa

Constant communication with vendors is crucial 30% of items as healthy choices is reasonable for

change Incentives may reinforce healthy vending choices May help to associate with another wellness event –

Live Healthy Iowa 100-day challenge Employee input on healthy choices can get their buy-

in More and more tasty products are available Set your sights at a reasonable level – beverages are

already there; shelf stable is a good place to start

NEMS-V Website

www.nems-v.com Intended to be a complete training tool, from

initial assessment to implementing changes

IOWA DEPARTMENT OF PUBLIC HEALTHIOWANS FIT FOR LIFECAROL VOSS 515-244-5566CAROL.VOSS@IDPH.IOWA.GOV

SUSAN KLEIN515-240-0368SUSANKLEIN50@GMAIL.COM

HEALTHY VENDING MACHINE PROJECT

Healthy Vending Machine Project Increase access to healthy foods and

beverages and reduce or eliminate the availability of calorie dense, nutrient poor foods in public service venues

Healthy Vending Machine ProjectGetting started:

Built on the school vending machine policies

Built on the state wellness discount Snack and beverage machines – state

run buildings/offices

Target audience – state employees Indirect audience – the public

Healthy Vending Machine Project WHY? 33% of active state employees are

OVERWEIGHT 48% of active state employees are

OBESE

State Employees in Comparison to the General Population

Healthy Vending Machine Project

Healthy Vending Machine Project Culture change!

Healthy Vending Machine Project What we wanted to do…

Create a healthy vending machine policy that included healthier items in machines in state offices

Healthy Vending Machine Project Getting started… Key Partners:

Alabama Department of Rehabilitative Services

Business Enterprise Program

Healthy Vending Machine Project Key Partners Continued: Alabama State Department of Education Governor’s Office Alabama Department of Agriculture and

Industries Alabama Department of Public Health State Employees Insurance Board State Obesity Task Force University of Alabama

Healthy Vending Machine Project Getting started…. Collaborated with Alabama Department

of Rehabilitation Services (ADRS) and their Business Enterprise Program Emphasized that funding was available to

provide subsidies to vendors if profit losses occurred

Negotiated implementation terms (% items, price, placing of items, etc.)

Healthy Vending Machine Project Initial policy: 50% of the items in the machines will be

healthy snacks that meet nutrition criteria

Healthy Vending Machine Project Nutrition Criteria: 10% or less of the Daily Value (DV) of total

fat (nuts and fruits are exceptions) 10% or less of the Daily Value (DV) of total

carbohydrate (nuts and fruits are exceptions)

5% or more of the Daily Value (DV) of at least one of the following nutrients: fiber, Vitamin A, Vitamin C, calcium, iron

360 mg or less of sodium

Healthy Vending Machine Project Nutrition Criteria cont. Preferred beverages include pure water,

non- carbonated flavored and vitamin enhanced water (without artificial flavorings), 100% fruit and/or vegetable juice (without artificial sweeteners) and diet soda.

Healthy Vending Machine Project

Pilot project… Identified partner agencies to implement the

policyADRS, Capitol, Agriculture & Industries, ADPHDept of Education - vendors not agreeable Invited private entities to participate- no

responses Met with Vendors-individually Worked with evaluator from the University of

Alabama to develop a vending machine assessment

Healthy Vending Machine Project Lunch & Learn education sessions

provided in pilot agencies Taste testing

Worked with UA to develop an employee snacking survey- sent out in early October

Pilot project started October 2010

Healthy Vending Machine Project Graphics developed for marketing:

Logo Good Choice Stickers Table tents to give tips and test

snacking knowledge Flyers Posters with Good Choice information

Healthy Vending Machine Project Healthy snacks are identified with a

Good Choice sticker Machines and break rooms contain Good

Choice materials (table tents, posters, machine toppers, flyers)

Healthy Vending Machine Project Developed a Webpage

http://www.adph.org/nutrition Click on Vending Machines

Suggested marketing materials for worksites to use

Policy and suggested guidelines for implementation

Media person for sustainability

Healthy Vending Machine Project The bottom line…….SALES Tracking sales data since beginning of

pilot Comparing current sales to sales from 1

year ago

Healthy Vending Machine Project There were losses initially

0-31%

Possible causes: Change Negative attitudes Economy Employee complaints (burn out, product

availability

Healthy Vending Machine ProjectOther challenges: Reimbursement (invoices) Vendors are upset Mixed support from ADRS

Healthy Vending Machine ProjectActions taken: Additional employee in-services Employee survey Meeting with ADRS accountant Follow up meetings with vendors Revised Policy:

30-100% of items in the machine will meet the nutrition criteria

Healthy Vending Machine ProjectSuccesses: Losses are not as bad as predicted Sales are improving, with trend of less loss

noted Additional, unexpected participants/partners(Canteen, Baptist Health Systems, Greil

Hospital, East Alabama Medical Center, AlaHA, City of Montgomery, Jackson Hospital, etc.)

A model policy for the Strategic Alliance and their wellness toolkit

Healthy Vending Machine ProjectNext steps….. Short term goal

Expanding to three additional state agencies this fall

Long range goalExpand to all state agencies at state and county

level offices

Healthy Vending Machine Project

Request Executive Order from the Governor –

Feb. 2012 (REVISING)

Healthy Vending Machine Project

Teresa B Fair, RD, LDAlabama Department of Public HealthNutrition and Physical Activity Division

teresa.fair@adph.state.al.us