Healthy Vending: Public Perceptions and Behaviors

Transcription

1 2016 Healthy Vending: Public Perceptions and Behaviors Report prepared by: Nevada Institute for Children s Research & Policy 7/30/2016

2 The Nevada Institute for Children's Research and Policy (NICRP) is a not-for-profit, non-partisan organization dedicated to advancing children's issues in Nevada. As a research center within the UNLV School of Community Health Sciences, NICRP is dedicated to improving the lives of children through research, advocacy, and other specialized services. NICRP's History: NICRP started in 1998 based on a vision of First Lady Sandy Miller. She wanted an organization that could bring credible research and rigorous policy analysis to problems that confront Nevada's children. But she didn't want to stop there; she wanted to transform that research into meaningful legislation that would make a real difference in the lives of our children. NICRP's Mission: The Nevada Institute for Children's Research and Policy (NICRP) looks out for Nevada's children. Our mission is to conduct community-based research that will guide the development of programs and services for Nevada's children. For more information regarding NICRP research and services, please visit our website at: NICRP Staff Contributors: Sarah Litterer Research Assistant Amanda Haboush-Deloye, Ph.D. Associate Director M. Amaris Fuller, M.Ed. Assistant Research Analyst Nevada Institute for Children s Research and Policy School of Community Health Sciences, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Las Vegas, NV (702) NICRP was contracted to produce this publication by the Southern Nevada Health District through Cooperative Agreement Number NU58DP funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. 2

3 TABLE OF CONTENTS INTRODUCTION... 4 MARKETING FOR HEALTHY VENDING... 4 HEALTHY VENDING RESEARCH... 5 PURPOSE OF THE CURRENT STUDY... 7 METHODS... 7 SURVEY DEVELOPMENT... 7 SURVEY ADMINISTRATION... 8 LIMITATIONS... 8 RESULTS... 9 DEMOGRAPHIC INFORMATION... 9 VENDING MACHINE PURCHASING BEHAVIOR OPINIONS ABOUT HEALTHY VENDING SUMMARY AND RECOMMENDATIONS SUMMARY Vending Machine Purchasing Behavior Opinions About Healthy Vending RECOMMENDATIONS REFERENCES APPENDIX A: UNLV VENDING USER SURVEY

4 INTRODUCTION The health of a community is often shaped by its nutrition environment. In many places, vending machines make up a sizeable portion of the available food service options. According to the Public health Law Center, vending machines are frequented by community members in city and county buildings, parks, and recreation centers, however they often sell snacks and beverages high in sugar, fat and salt, with little nutritional value (PHLC, n.d.). Healthy vending policies are designed to replace these unhealthy food and beverages with healthier options to increase access to nutritious choices for consumers. Healthy vending guidelines typically require items to meet specified nutrition standards. These guidelines will often specify limits on the percentage and/or total amount of calories, fat, sugar, and sodium that an item may contain. The guidelines may also be designed to address specific nutritional factors (such as the amount of saturated fat, added sugar, or whole grains in an item) as well as portion size. Healthy vending policies may also set rules regarding the following: The placement of items in vending machines, Differences in pricing between regular and healthier items, Making certain items exempt from the established standards, Limitations on the types of advertising that can appear on vending machines, and The percentage of items in each vending machine that must meet the healthy vending guidelines and deadlines for implementation of these ratios. While healthy vending and concessions policies have been put in place for federal government facilities by the U.S. General Services Administration (GSA) and the U.S. Department of Health and Human Services (HHS), policies for healthy vending in public places may also be adopted at the state, county, municipal or department (i.e. Parks and Recreation) level. State and local public health agencies often provide assistance and help to establish the criteria for healthy vending programs. These policies typically mirror elements of federal guidelines or follow established policies from other successful healthy vending programs that have already been implemented. Private businesses, worksites, hospitals, and many other organizations can also develop their own healthy vending guidelines, with or without assistance. Public health entities across the country as well as nonprofit and research organizations have developed a variety of healthy vending resources. Numerous resources to support the development and implementation of healthy vending policies can be found online, including free toolkits, signage, educational resources, templates, and sample policy language. Many of these were specifically developed with municipalities and other public entities in mind, but can be easily modified to serve most nutrition environments in which vending plays a role. Healthy vending policies can easily be implemented as one way to improve community nutrition environments by increasing access to healthy foods and beverages. Marketing for Healthy Vending Marketing strategies that can be utilized to help increase sales of healthier food and beverage options are commonly referred to as the 4 Ps : product, promotion, price, and placement (Nemours Health and Prevention Services, 2010). Product refers to availability; there must be healthy food and beverage items available in order for consumers to be able to make better nutritional choices. Additionally, increased availability helps to make it easier for people to make healthier selections if healthy foods and beverages comprise the majority of items offered. Promotion of products can include providing labels and motivational signs on vending machines; clearly 4

5 marking items that are low in calories, sugar, fat, etc. using labels on packaging; stickers for the machines or food products; and other signage designed in order to increase awareness of healthier options (Nemours Health and Prevention Services, 2010). Research has shown that using promotional approaches to healthy vending does increase purchasing of healthier options and does not negatively impact overall sales (Nemours Health and Prevention Services, 2010). Price can serve as another incentive to stimulate sales of healthier items. One study noted an 80% increase in sales of low-fat snacks when prices were cut in half during a three week trial and, to the researchers surprise, overall revenue did not suffer (Nemours Health and Prevention Services, 2010). Similarly, instead of reducing the prices of healthier items, prices of less healthy choices could be raised to help achieve similar shifts in purchasing. Finally, placement of items can also impact the sale of healthier food and beverage options. For instance, if more nutritional items are placed in prime locations within the machine, such as at eye level, the purchase rate of those items will increase (Nemours Health and Prevention Services, 2010). Healthy Vending Research There is a significant gap in the literature when it comes to broad, community-based research related to healthy vending. Much of the peer-reviewed, published material available focuses primarily on specific interventions or policy changes affecting elementary and secondary schools, which are governed by strict legislation detailing both specific nutrition guidelines and what types of items can be sold. Studies involving adults focus largely on the workplace or only mention healthy vending as a component of broader program implementation and initiatives. A 2004 survey conducted by Kruger et al. examined employee attitudes towards worksite health promotion services, specifically focusing on barriers and incentives to employee involvement and use of these programs. One of the proposed strategies to improve workplace wellness included a focus on nutrition, particularly improving the availability of healthy options in worksite cafeterias and vending machines. Based on the survey results, the researchers identified changes to the workplace environment as a key component of successful health promotion programs, particularly for workplaces with limited budgets for wellness programs (Kruger et al., 2004). Results of the survey also indicated that the policy practice of offering healthy food in vending machines or cafeterias was preferred by 77.5% of respondents and many felt that these sorts of changes would help them eat a healthier diet (Kruger et al., 2004). This strong support among respondents for increased availability of healthy options at work suggests opportunities to foster healthy eating through environmental and policy changes (Kruger et al., 2004). The researchers proposed that the survey s findings could be useful for employers working to develop health promotion programs that will be attractive to employees, particularly in combination with their own workforce needs assessment data (Kruger et al., 2004). One study addressed the effects of increasing availability and lowering prices of healthy vending items as part of a workplace intervention for obesity prevention. The researchers used vending machines at four bus garages; at two locations the availability of healthy items was increased to 50% and prices were lowered an average of 31%, while the other two locations were unchanged (French et al., 2010). French et al. found that these changes were associated with greater purchases of these items over an eighteen-month period, noting 10-42% higher sales of healthy items and that pricing appeared to be the factor that employees responded to most (French et al., 2010). 5

6 An earlier study led by the same researcher looked at both pricing and promotional strategies for healthy vending in both schools and workplaces. After adding low-fat snacks to the vending machines at these sites, four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were utilized and monitored over a 12-month period (French et al., 2001). The study found that all three price reduction levels (10%, 25%, and 50%) led to significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively; the promotional signage did not have a strong impact on the sales of the healthier snacks (French et al., 2001). However, the study determined that the pricing promotional strategy was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations without affecting the profitability of the vending machines (French et al., 2001). Vending on College Campuses Environments that promote healthy nutrition choices can make it easier to reach or maintain health goals, particularly when compared with environments without access to healthy food choices (Byrd-Bredbenner et al., 2012). However, college campuses do not typically have healthy vending policies in place (Brown, Flint, & Fuqua, 2014). Vending sales on post-secondary campuses are a significant source of revenue. It is estimated that in 2012, approximately 6.6% of this billion industry came from post-secondary campuses (Brown, Flint, & Fuqua, 2014). In recent years, there has been increasing research on the topic of healthy vending overall, including specific applications in collegiate environments; however, the quantity of relevant and recent literature is still quite small and significant gaps exist in the research. A recent study analyzed the nutritional quality of snacks and beverages offered in vending machines in hightraffic areas at eleven post-secondary campuses across the United States. The researchers found that campus vending machines offered few healthy options. In fact, salty snacks and sweets were the most widely available items in snack machines and beverage machines (Byrd-Bredbenner et al., 2012). Many snacks and beverages were very high in calories and sugar (Byrd-Bredbenner et al., 2012). Environments that promote healthy food choices can make it easier for people to maintain their health, and college campuses are unique in their ability to simultaneously impact the nutrition environments of both employees and students (Byrd-Bredbenner et al., 2012). Arguably, adults should be allowed to make their own choices when it comes to nutrition; unfortunately, individuals are currently limited in their ability to make healthy choices due to the lack of availability of healthy items in vending machines (Byrd-Bredbenner et al., 2012). In 2013, a qualitative study on the campus nutrition environment was conducted at the University of Alabama at Birmingham to address students perceptions of opportunities and challenges to eat healthy on campus (Burnett, 2013). There was an overall feeling among students that the foods available were unhealthy and there was limited access to healthier food. In addition, students felt that the existing healthy options were not of good quality (Burnett, 2013). In addition to other elements of the campus nutrition environment, the participants were also asked about vending machines on campus. Participants had largely negative views of vending on campus, particularly due to the lack of availability of healthy items and expressed frustration that even the healthy vending options offered were very limited or simply mislabeled unhealthy choices (Burnett, 2013). The study found that many students wanted a way to quickly access healthy foods on-the-go and participants suggested that vending machines may be one way for the university to accomplish this and better support a healthy environment (Burnett, 2013). 6

7 A nutrition intervention centered on university vending machines was conducted in 2011 following five frequently used machines. After baseline data was collected, each of the items in the five vending machines received a color-coded sticker based upon the traffic light system of red, yellow, or green, a commonly used method in healthy vending programs (Brown, Flint, & Fuqua, 2014). Red stickers identify the least healthy items, moderately healthy items are marked with yellow stickers, and the healthy items receive green stickers. These stickers are designed to not only identify how healthy an item is, but also how frequently they should be consumed: red means Stop or Eat Sparingly, yellow means Slow Down or Eat Moderately, and green means Go or that there are no recommended restrictions on these items. In this intervention, a large sticker was placed on each vending machine above the selection button(s) explaining the traffic light system and describing the nutrition criteria for each category; posters marketing the initiative were put up on campus as well (Brown, Flint, & Fuqua, 2014). After a two week period, the intervention was evaluated. The researchers noted that overall sales increased slightly during the intervention period (by 2.4%); there were also small decreases in the sales of red items (4.8%) and yellow items (15.2%) and a much larger, statistically significant increase in the sales of green items (50.8%) (Brown, Flint, & Fuqua, 2014). The researchers believe that this increase indicates support for having more healthy options available in vending machines (Brown, Flint, & Fuqua, 2014). Purpose of the Current Study This survey was conducted as an activity associated with the Partnerships to Improve Community Health Year 2 Project Period Objective 2.0: Increase the number of people with access to environments with healthy food and beverage options from 0 to 389,116 (19% of population) by Specifically, the purpose of this study was to gather information from the community to learn more about their opinions and behaviors related to vending and the role of vending machines in nutrition environments. The survey was also designed to gather information specifically about respondents attitudes towards components of healthy vending initiatives, as well as their current vending machine purchasing behaviors. METHODS Survey Development In collaboration with SNHD staff in the Office of Chronic Disease Prevention and Health Promotion, NICRP staff developed a survey to assess the vending use behaviors, opinions regarding food options available in vending machine, and healthy vending guidelines. Content of the survey was developed by conducting extensive research on healthy vending, including reviewing the available literature and assessing content from other relevant surveys. Once a draft was complete, NICRP solicited feedback from SNHD and conducted a brief internal test of the survey to make final edits. The final survey consisted of 18 questions: 4 demographic questions, 3 questions about the role of vending machines in nutrition environments, 5 questions regarding opinions and perceptions related to healthy vending, 5 questions about current vending purchasing behavior, and one question about factors affecting vending item selection. The contents of the final survey are provided in Appendix A. 7

8 Survey Administration The survey was designed to be administered in person and completion time should take no longer than 5 minutes. Two NICRP staff members were trained to administer the surveys on the UNLV campus. Surveys were completed at various campus locations on between April 25 and May 13, Data collection was completed in high traffic areas, such as the Student Union, Lied Library, and free-speech zones across campus. In order to ensure representation from faculty and staff members in the final survey sample, survey administrators also visited office and classroom buildings on the UNLV campus. As an incentive to complete the survey, respondents were offered a snack item that met health nutritional guidelines (pretzels, trail mix, granola bar). Survey respondents had the ability to skip any questions they could not or did not wish to answer and still receive the incentive upon completion of the survey. Limitations There are few limitations to note regarding this research. Primarily, relying on self-reported data may result in limitations based on respondent biases or inaccurate reporting. In addition, the printed survey was only made available in English, which could have potentially excluded some members of the community. Finally, because the survey was conducted on a college campus, the results may not be generalizable due to differences between the pool of individuals from whom surveys were received and the general population of Clark County, NV. 8

9 RESULTS A total of 475 surveys were collected from individuals 18 years or older on the campus of the University of Nevada Las Vegas. Provided below is a description of the responses to each of the 18 survey questions. The results of the report will be divided into three main sections, demographic information, vending machine purchasing behavior, and opinions about healthy vending. For the sections on vending machine purchasing behavior and opinions about healthy vending, results are presented by age and by vending use. Understanding differences within these subgroups will assist with the development of appropriate strategies to increase access to healthier foods. Demographic Information The following tables provide the demographic characteristics for the 475 respondents who completed the survey. The majority of respondents were 18 to 21 years old (Table 1) and 72.2% were students (Table 4). These results appear to indicate that most of the survey respondents were traditional undergraduate students. Table 1: Age (n=475) Table 2: Gender (n=475) years old 66.1% Male 41.7% years old 12.3% Female 56.2% years old 9.0% Other 1.3% years old 3.9% Unknown 0.8% years old 2.6% 60+ years old 1.0% Unknown 4.8% Table 3: Race (n=475) Table 4: Role on Campus (n=475) American Indian/Alaska Native 0.6% Student 72.2% Asian 18.7% Academic/Administrative Faculty 9.5% Black/African American 9.5% Staff 15.5% Caucasian/White 34.3% Multiple 1.7% Hispanic/Latino 18.9% Unknown 1.1% Native Hawaiian/Other Pacific Islander 2.1% Note. Some faculty and staff also reported being students. Other 1.7% Multiple 12.6% Unknown 1.5% 9

10 Vending Machine Purchasing Behavior This section will provide information regarding participants self-reported vending behaviors. Results for vending behaviors will be compared between those aged under 24 versus those who are 24 and older to determine if differences exist which will help understand if these results can be generalized to the community at large. Even though data were collected on a college campus, the UNLV community has a diverse student and faculty population that could provide a more comprehensive snapshot of the area s general population. However the education level of respondents is still likely higher than the community as a whole which should be considered when moving forward with recommendations. A majority of respondents (73.5%) indicated that they use vending machines, and among those who do use vending machines 60.9% purchase both food and beverage items. Respondents ages 24 and older were slightly more likely to use vending machines (78.6%) than respondents under the age of 24 (73.1%). Among vending machine users, purchasing behaviors appear to be similar, regardless of age. Table 5: Vending Machine Purchasing Behavior All (n=472) Under 24 (n=312) 24 and Over (n=140) Use Vending Machines 73.5% 73.1% 78.6% Do Not Use Vending Machines 26.5% 26.9% 21.4% Among Those Who Use Vending Machines: All (n=338) Under 24 (n=228) 24 and Over (n=110) Food 14.8% 16.7% 10.9% Beverages 24.3% 23.7% 25.5% Both Food and Beverages 60.9% 59.6% 63.6% Vending Machine Non-Users When looking at overall vending machine behavior, it is just as important to understand people s reasons for not using the service as it is for those who do. During the current survey, a little over one fourth (26.5%) of respondents reported that they do not use vending machines. In order to determine common barriers to using vending machines, these respondents were asked a follow up question regarding their reasons for this decision. The top three reasons reported were high prices of items (58.0%), the respondents dislike of the available options (46.4%), and the minimal availability of healthy items (43.8%). Although high item prices were the number one reason listed regardless of age, respondents 24 and older were more likely to cite a lack of healthy options as the second most significant reason for not using vending machines (55.2%, compared to 39.8% for respondents under the age of 24). 10

11 Percent of Respondents 70.0% 60.0% 50.0% 40.0% Figure 1: Reasons for Not Using Vending Machines (n=112) 62.1% 58.0% 55.2% 56.6% 48.2% 46.4% 43.8% 41.4% 39.8% 37.9% 30.0% 20.0% 10.0% 10.7% 7.2% 20.7% 27.7% 24.1% 13.8% 8.0% 9.6% 8.9% 7.2% 3.4% 0.0% Dietary restrictions I don t like the options Not enough healthy items are available Item prices are too high Reasons for Not Using Concerned about the freshness of items Vending machines are not easily accessible Other All (n=112) Under 24 (n=83) 24 and Over (n=29) Note: This graph only reflects answers of those who reported they do not use vending machines (Table 5). Percentages may exceed 100% as respondents were able to select multiple options. Among respondents who selected Other, specified responses mostly fell into two main categories: Financial restraints: o They do not carry cash or do not want to use cash-only machines. o They have concerns about using credit/debit cards with vending machines. o They are worried about the machines taking their money but not dispensing their selected item(s). o They avoid using vending machines in order to save money. Personal beliefs and preferences: o Not caring to do so (for example, not being interested in using vending machines or preferring to buy food from other food service options on campus). o Self-described laziness. Vending Machine Users In order to obtain a clearer picture of current vending machine habits, respondents who reported using machines were asked a series of questions about factors related to their vending machine use and decision making. A majority of all respondents (73.5%) indicated that they use vending machines to purchase food and/or beverages. Most respondents (75.8%) make purchases from vending machines while at school, with 31.4% make purchases while at work. This large difference is to be expected since 72.2% of respondents reported being students (see table 4). A significant majority (93.3.%) of the respondents who use vending machines are infrequent users, with 69.3% of making less than one purchase per week and additional 24.0% making only 1 or 11

12 Percent of Respondents 2 weekly purchases, on average. Only 6.7% of respondents make an average of 3 or more vending purchases per week (see Table 6) % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Figure 2: Where Respondents Typically Use Vending Machines (n=338) 89.3% 75.8% 58.3% 47.6% 31.4% 18.6% 5.7% 5.1% School Work Other Location All (n=318) Under 24 (n=215) 24 and Over (n=103) 6.8% Note: This graph only reflects answers of those who reported using vending machines (Table 5). Percentages may exceed 100% as respondents were able to select multiple options. Descriptions provided for Other locations where respondents use vending machines included: Airport At events Grocery store At home Hotels Library Malls Parks Public Places Restaurants Table 6: Frequency of Vending Machine Purchases All (n=313) Under 24 (n=212) 24 and Over (n=101) Less than once per week 69.3% 70.8% 66.3% 1 2 times per week 24.0% 22.6% 26.7% 3 4 times per week 5.4% 4.7% 6.9% 5 6 times per week 1.0% 1.4% 0.0% 7 or more times per week 0.3% 0.5% 0.0% Note: This question only reflects answers of those who reported using vending machines (Table 5). Respondents who use vending machines were asked to write in the food and beverage items that they purchase the most often. Some respondents filled in more than one item per category, while others left these sections blank or answered illegibly. Items incorrectly categorized (food items written in as beverages and beverages written in as food items) were counted along with responses in the correct categories. The details provided in the two figures below are taken from all items listed by respondents who both indicated that they use vending machines and filled in at least one legible answer for the survey questions regarding their most frequent food and/or beverage purchases. 12

13 Quantity of Item When looking at food/snack items (Figure 3), chips and candy account for the vast majority of vending machine purchases, at 41.0% and 30.5%, respectively. All other types of items combined account for 28.4% of snack vending purchases Figure 3: Most Frequently Purchased Snack Item (n = 249) Type of Item Note: This graph only reflects answers of those who reported using vending machines (Table 5). Respondents were able to write in multiple items for this category. Beverage selections (Figure 4) were almost evenly split between non-diet soda (31.5%) and water (31.2%). The relatively high percentage of water sales may result from consumers being more nutrition conscious, but could also be related to the significant need for hydration caused by the area s desert climate. All other types of beverages combined accounted for 37.4% of beverage vending purchases. 13

14 Quantity of Item Figure 4: Most Frequently Purchased Beverage Item (n = 311) Soda (non-diet) Water Sports Drinks Iced Teas Diet Soda Energy Drinks Juice Other Type of Item Note: This graph only reflects answers of those who reported using vending machines (Table 5). Respondents were able to write in multiple items for this category. Factors Affecting Vending Item Selection A number of factors affect how individuals select the items that they want to purchase from vending machines. One of the key influences identified by respondents as a significant factor in determining what items they purchase was how hungry the person is, with 98.0% of users considering this to be very important (66.2%) or somewhat important (31.8%). Financial considerations were another substantial influence. The price of the item was another key consideration for 94.9% of respondents, with 53.6% classifying it as very important and 41.3% as somewhat important. Interestingly, a majority of respondents under age 24 (56.5%) considered this factor to be very important, whereas respondents 24 and over were evenly split between very and somewhat important (47.6% each). The other financial element was getting the best value for one s money, which mattered to 92.4% of those surveyed, with 56.2% ranking it as very important and 36.2% considering it to be somewhat important. Overall, respondents under 24 were more likely to consider these financial factors to be very important than those 24 and over. Contrary to popular perception that vending machine customers are almost exclusively focused on buying their favorite or usual food and beverage items, only 34.8% of those surveyed considered this to be a very important factor affecting their decision making and purchasing. It was identified by 50.2% of respondents as being only somewhat important. Nutritional considerations seemed to be a slightly lower priority among consumers surveyed. 61.5% of vending machine users viewed how healthy an item as only a somewhat important factor. While 18.0% of respondents considered this to be very important, slightly more respondents (20.5%) stated that they do not consider the healthiness of items at all when making vending purchases. A majority of respondents (55.7%) also considered 14

15 nutritional content to be a somewhat important element in their decision making. Again, the results for this factor were similar to those for healthiness of items, with 22.6% prioritizing it as very important factor and 21.7% stating that this factor was not at all important to them. Watching one s weight appeared to be the least important health factor considered by respondents; 40.0% identified it as only somewhat important and 39.4% considered it to be not at all important. Interestingly, for all three nutrition-related factors, respondents 24 and over were more likely to categorize nutritional factors as very or somewhat important to their item selection. Table 7: Factors Affecting Vending Item Selection How Hungry I Am All (n=314) Under 24 (n=212) 24 and Over (n=102) Very Important 66.2% 68.9% 60.8% Somewhat Important 31.8% 28.3% 39.2% Not at All Important 1.9% 2.8% 0.0% The Price of the Item All (n=317) Under 24 (n=214) 24 and Over (n=103) Very Important 53.6% 56.5% 47.6% Somewhat Important 41.3% 38.3% 47.6% Not at All Important 5.0% 5.1% 4.9% Getting the Best Value for My Money All (n=315) Under 24 (n=212) 24 and Over (n=103) Very Important 56.2% 59.0% 50.5% Somewhat Important 36.2% 35.4% 37.9% Not at All Important 7.6% 5.7% 11.7% Buying My Usual Snack All (n=313) Under 24 (n=212) 24 and Over (n=101) Very Important 34.8% 35.8% 32.7% Somewhat Important 50.2% 47.6% 55.4% Not at All Important 15.0% 16.5% 11.9% How Healthy an Item Is All (n=317) Under 24 (n=214) 24 and Over (n=103) Very Important 18.0% 19.6% 14.6% Somewhat Important 61.5% 57.9% 68.9% Not at All Important 20.5% 22.4% 16.5% The Item s Nutritional Content All (n=314) Under 24 (n=213) 24 and Over (n=101) Very Important 22.6% 23.0% 21.8% Somewhat Important 55.7% 52.6% 62.4% Not at All Important 21.7% 24.4% 15.8% Watching My Weight All (n=315) Under 24 (n=213) 24 and Over (n=102) Very Important 20.6% 20.2% 21.6% Somewhat Important 40.0% 37.6% 45.1% Not at All Important 39.4% 42.3% 33.3% 15

16 Opinions about Healthy Vending In the following section, results are again presented by age and by vending use to have a better understanding on how to create strategies that will increase access to healthier foods in Southern Nevada. The Role of Vending Machines in Nutrition Environments Among those surveyed, there is significant support for the idea that vending machines can and should play a role in the creation of healthy environments by offering healthier food and beverage options. When asked about this role, 80.8% of survey respondents believe that vending machines can be part of a healthy environment and 82.9% of respondents think that having healthier food and beverage options available in vending machines can help improve the overall health of the environment. Additionally, 85.9% of survey respondents think that vending machines should have healthier food and beverage options available in order to improve the overall health of the environment. There do not appear to be any major differences between respondents based on age, however vending machine users are more likely to believe that vending machines can be part of a healthy environment (84.4%, compared to 70.4% of non-users). In contrast, non-users were nearly three times more likely to state that vending machines cannot be part of a healthy environment (15.2%, compared to 5.5% of vending machine users). Table 8: Beliefs about the Role of Vending Machines in Nutrition Environments Vending Machines Can Be Part of A Healthy Environment All (n=474) Under 24 (n=313) 24 and Over (n=141) Use Machines (n=346) Do Not Use Machines (n=125) Yes 80.8% 79.6% 83.7% 84.4% 70.4% No 8.0% 6.7% 9.2% 5.5% 15.2% Unsure 11.2% 13.7% 7.1% 10.1% 14.4% Healthier Food/Beverage Options in Vending Machines Can Help Improve the Overall Health of Environment All (n=474) Under 24 (n=314) 24 and Over (n=140) Use Machines (n=346) Do Not Use Machines (n=125) Yes 82.9% 81.8% 85.7% 83.2% 81.6% No 7.2% 7.6% 6.4% 7.5% 6.4% Unsure 9.9% 10.5% 7.9% 9.2% 12.0% Vending Machines Should Have Healthier Food/Beverage Options to Improve Overall Health of Environment All (n=474) Under 24 (n=313) 24 and Over (n=141) Use Machines (n=346) Do Not Use Machines (n=125) Yes 85.9% 85.9% 85.8% 86.4% 84.8% No 4.9% 4.8% 5.0% 5.5% 3.2% Unsure 9.3% 9.3% 9.2% 8.1% 12.0% Opinions and Perceptions Related to Healthy Vending Respondents were also asked about their opinions of vending machines and whether they consider them to offer healthy options. Out of all respondents, 54.6% think that current food and beverage options available in vending machines are mostly unhealthy. Also, only 31.0% of respondents feel that there are at least some healthy options available; though there does not appear to be a difference in responses based on age (see Table 16

17 9). Those who use vending machines were almost twice as likely as those who do not use vending machines to think that there are at least some healthy options available (35.2%, compared to 19.2%). In addition to establishing nutrition guidelines in order to determine if items qualify as healthy, healthy vending policies often also stipulate what percentage of items in each vending machine must meet the healthy vending guidelines. Respondents were asked their opinions regarding how much of a percentage of vending machines should be comprised of healthy items to be considered a healthy vending machine. A high majority of respondents (89.5%) felt that 50% or more of items should be required to meet these guidelines in order for the contents of the vending machine to be categorized as healthy. Non-users were nearly three times more likely to state that 100% of vending machine contents should be required to meet healthy vending nutrition guidelines (14.8%, compared to 5.2% of vending machine users). Table 9: Opinion on Current Food/Beverage Options Available in Vending Machines All (n=471) Under 24 (n=310) 24 and Over (n=141) Use Machines (n=344) Do Not Use Machines (n=125) Mostly healthy 1.5% 1.0% 2.1% 1.2% 2.4% Some healthy 29.5% 29.0% 30.5% 34.0% 16.8% Mostly unhealthy 54.6% 56.1% 53.2% 54.1% 56.0% Only unhealthy 8.7% 8.1% 9.2% 6.7% 14.4% Unsure 5.7% 5.8% 5.0% 4.1% 10.4% Table 10: Opinion on the % of Vending Machine Items that SHOULD Meet Healthy Nutrition Guidelines All (n=469) Under 24 (n=309) 24 and Over (n=140) Use Machines (n=345) Do Not Use Machines (n=122) 100% 7.7% 7.4% 8.6% 5.2% 14.8% Over half 42.4% 43.7% 40.7% 42.0% 43.4% 50% 39.4% 38.8% 39.3% 42.3% 32.0% Under half 7.9% 8.4% 7.1% 7.5% 8.2% None 1.1% 0.3% 2.9% 1.4% 0.0% Unsure 1.5% 1.3% 1.4% 1.4% 1.6% Respondents were also asked whether they would like to see more healthy options available in vending machines and whether that would make them more likely to purchase and item from the machine. There was high approval for healthier items, with 88.1% of respondents who would like to see healthier food and beverage options made available in vending machines (see Table 11). Also, a majority of respondents (52.7%) agreed that they would be more likely to make vending machine purchases if healthier choices were available, and another 34.8% said that increased availability of healthier options might make them more likely to purchase something from a vending machine (see Table 12). Table 11: Would Like to See Healthier Food/Beverage Options in Vending Machines All (n=471) Under 24 (n=311) 24 and Over (n=140) Use Machines (n=344) Do Not Use Machines (n=124) Yes 88.1% 86.2% 92.1% 89.5% 83.9% No 3.2% 2.9% 3.6% 3.5% 2.4% Unsure 8.7% 10.9% 4.3% 7.0% 13.7% 17

18 Percent of Respondents Table 12: Would Be More Likely to Purchase Healthier Food/Beverage Options All (n=469) Under 24 (n=310) 24 and Over (n=140) Use Machines (n=343) Do Not Use Machines (n=123) Yes 52.7% 52.6% 52.1% 55.1% 44.7% Maybe 34.8% 35.5% 34.3% 34.7% 35.8% No 10.2% 9.7% 10.7% 8.2% 16.3% Unsure 2.3% 2.3% 2.9% 2.0% 3.3% Respondents were provided with a list of methods that could be utilized to make it easier for consumers to identify healthier items in vending machines. These options were based on established practices of successful healthy vending programs. Half (50.2%) of the respondents felt that signs on vending machines providing items nutrition information would be a useful tool to help them identify healthier choices. Also, 51.9% thought that having stickers or labels identifying healthier items in machines would be a helpful identification tool. Additionally, 43.9% of respondents stated that simply increasing the availability of healthier options would be beneficial. Although there does not seem to be much overall variation between the groups of respondents, those who do not use vending machines were much more likely to select simply increasing availability as a way to make it easier to identify healthy choices (53.6%, versus 40.2%-47.1% among other groups). 60.0% 50.0% 40.0% Figure 5: Options That Would Help Identification of HealthierFood/Beverage Choices When Using Vending Machines 55.7% 51.9% 50.2% 50.0% 50.0% 51.2% 50.6% 51.7% 52.0% 47.2% 47.1% 43.9% 42.7% 40.2% 53.6% 30.0% 20.0% 10.0% 0.0% Stickers/labels identifying healthier options Signs on machines providing nutrition information Option Increased availability of healthier items 2.5% 3.2% 1.4% 2.6% Other 2.4% All (n=474) Under 24 (n=314) 24 and Over (n=140) Use Machines (n=346) Do Not Use Machines (n=125) Note: Percentages may exceed 100% as respondents were able to select multiple options. Specified responses from those who chose the Other option included: The items currently in vending machines and the existing product labels are self-explanatory. Items themselves could serve as useful indicators, especially if the packaging included more visible nutrition facts (specifically, calories and more detailed ingredient lists should be made highly visible). Suggesting having separate vending machines stocked with only healthy items installed next to machines stocked with traditional vending items. 18

19 SUMMARY AND RECOMMENDATIONS Summary The purpose of the current study was to gather information from the community to learn more about their opinions and behaviors related to vending and the role of vending machines in nutrition environments. The survey was also designed to gather information specifically about respondents attitudes towards components of healthy vending initiatives, as well as their current vending machine purchasing behaviors. The overall arching results are discussed below. Even though data were collected at a university, results determined that there were only small differences by age and that those who use vending machine do so outside of the university. Therefore the overall results should be applicable outside of the university setting, however additional data collected within the community would still be beneficial. Vending Machine Purchasing Behavior Vending Machine Non-Users Approximately one quarter of respondents (26.5%) indicated that they do not use vending machines. The three main reasons given for non-use by these respondents were high prices (58.0%), not liking the available options (46.4%), and that not enough healthy items are available (43.8%). Though price was the primary reason for nonuse selected regardless of age, respondents age 24 and over were more likely to cite a lack of healthy options as a significant reason for not using vending machines. Therefore increasing health options may increase the use of vending machines. Vending Machine Users The majority of respondents (73.5%) indicated that they use vending machines, and 60.9% of vending machine users purchase both food and beverage items. Among these users, purchasing behaviors appear to be largely similar, regardless of age. Almost all respondents (93.3%) do not frequently use vending machines: 69.3% make less than one purchase per week on average and 24.0% more make only 1 or 2 average weekly purchases. Only 6.7% of respondents make an average of 3 or more vending purchases per week. Chips and candy comprised 71.5% of the most frequently purchased snack items. Top beverage purchases were almost evenly split between non-diet soda (31.5%) and water (31.2%), with all other types of beverages combined accounting for 37.4% of regularly purchased items. The top three factors influencing vending machine item selection were hunger level (98.0% very/somewhat important), item price (94.9% very/somewhat important), and getting the best value for one s money (92.4% very/somewhat important). Respondents under age 24 were more likely to consider financial factors to be very important than those 24 and over. Nutritional considerations appeared to be influential factors affecting item selection among the vending users surveyed, though less so than hunger or financial concerns. 61.5% of vending users considered how healthy an item is as only somewhat important; the remaining respondents were almost evenly split between those who felt it was very important and those who felt that it was not important at all (18.0% and 20.5% respectively). Responses assessing the impact of nutritional content on item selection closely mirrored these results: 55.7% 19

20 of respondents felt it was somewhat important, 22.6% felt that it was very important, and 21.7% felt it was not important at all. Watching one s weight was the least influential health factor considered by these respondents, with 39.4% considering it not to be at all important. For all three nutrition related factors, respondents under age 24 were more likely to say that these elements did not affect their decision making at all when it comes to selecting vending items. Respondents 24 and over were slightly more likely to categorize nutritional factors as very or somewhat important to their item selection. Opinions About Healthy Vending There is overwhelming support among respondents for the potential of vending machines to be part of a healthy environment. Not only did 80.8% of survey respondents believe that vending machines can be part of a healthy environment, 82.9% of those surveyed think that having healthier food and beverage options available in vending machines could help improve the overall health of environments. Additionally, 85.9% of respondents also felt that vending machines should offer healthier items in order to achieve this effect. While adults 24 years or older were slightly more likely to agree that vending machines can be part of a healthy environment and that healthier options can help improve overall health, individuals in both age groups highly agree that vending machines SHOULD have healthier options (<24=85.9%; 24+=85.8%). Vending machine users were more likely to believe that the machines can be part of a healthy environment (84.4%, compared to 70.4% of non-users), and non-users were nearly three times more likely to state that vending machines cannot be part of a healthy environment (15.2%, compared to 5.5% of vending machine users). There is a perception among all respondents that most current vending options are unhealthy (54.6% report feeling this way) and only 31.0% feel that there are currently healthy options available. Though the majority of both groups think that most current options are unhealthy, those who use vending machines were almost twice as likely as those who do not use vending machines to think that there are at least some healthy options available (35.2%, compared to 19.2%). These results suggests that strategic improvements should be made that would focus on both providing more positive examples of how vending machines can play a role in a healthy environment and increasing awareness of the availability of healthy items among non-users. Both strategies can help healthy vending programs succeed and even increase the usage of vending machines. Furthermore, respondents also support having a majority of vending items that meet healthy vending guidelines in order for the contents of the machine to be categorized as healthy; 89.5% of respondents supported the idea that between 50% and 100% of items in vending machines should have to meet specified nutrition guidelines. Non-users were nearly three times more likely to state that 100% of vending machine contents should be required to meet healthy vending nutrition guidelines (14.8%, compared to 5.2% of vending machine users). While this may be seen as an unrealistic request by vending machine suppliers, it is important to help non-users become more aware of increased availability of healthier items to show progress and support of their needs for healthy options. There is also support for increasing the availability of healthy options in vending machines, with 88.1% of those surveyed stated that they would like to see healthier food and beverage options made available. Adults 24 years or older were slightly more likely than younger respondents to report wanting to see more healthy options in vending machines (<24=86.2%; 24+=92.1%), but would be just as likely to make purchases at machines if healthier options were available. Their numbers match those of the overall rates which suggest that taking action to increase availability may potentially drive up sales at vending machines, since 87.5% of respondents said that they might be more likely (yes=52.7%, maybe=34.8%) to make vending machine purchases if healthier 20

21 choices were available. Even 80.5% of non-users indicated that they might be more likely (yes=44.7%, maybe= 35.8%) to use vending machine if healthier items were available suggests that merely increasing availability may not be enough to encourage this group to change their purchasing habits. When provided with a list of ways to make it easier for consumers to identify healthier items in vending machines, respondents identified the following as the top three strategies: 50.2% of respondents felt that signs on machines providing items nutrition information would be useful, 51.9% thought that having stickers or labels identifying healthier items in machines would be helpful, and 43.9% of respondents stated that simply increasing the availability of healthier options would be beneficial. Responses across all groups were largely consistent; however, those who do not use vending machines were much more likely to select simply increasing availability as a way to make it easier to identify healthy choices (53.6%, versus 40.2%-47.1% among other groups). These results indicate that it may be most beneficial to use a multi-tiered approach to identifying healthy items in machines that have the potential to capture the attention of the most people. 21

22 Recommendations Healthy vending policies can be implemented as a way to improve community nutrition environments by increasing access to healthy foods and beverages. The results of this study are a useful step in beginning to gather more information about wider community behaviors related to vending machine use and opinions regarding healthy vending policies. These findings can be used to help demonstrate to vending providers as well as public and private entities considering the development and implementation of healthy vending policies that: 1. Consumers believe that vending machines can impact their nutrition environments. 2. Strong support exists for healthy vending programs among consumers. 3. Consumers feel that current vending machines choices are unhealthy and that vending machines should include more healthy food and beverage options. 4. Consumers would be more likely to make vending machine purchases if healthier items were made available. 5. Changes needed to successfully implement healthy vending initiatives are often simple and affordable solutions (adding nutrition information on signage, identifying healthy items using stickers/labels, shifting stock to alternative items that meet nutrition guidelines, etc.). 6. Individuals who do not currently use vending machines would be more likely to do so if their reasons for non-use were addressed (offering different and healthier items, incorporating successful pricing strategies, etc.). 7. Though a majority of people use vending machines, most consumers are infrequent users; it would be beneficial to offer healthier items that they would be more likely to purchase to potentially increase their frequency of use. 8. Even among current vending items with traditionally high sales, easy substitutions can be made with comparable items that meet recommended nutrition guidelines. 9. Many other factors, particularly hunger level and cost, are more important to most consumers than being able to buy a usual item. 10. Although secondary to financial considerations, nutrition-related factors are at least somewhat important to a majority of current vending machine users, particularly those age 24 and over. Similar surveys should be conducted at other venues to determine if comparable levels of support exist among the relevant stakeholders and to help shape policies specific to those nutrition environments. More detailed questions could also be added to determine specific options for alternative items that could be easily stocked by vending providers, meet established healthy vending criteria, and would still be popular among consumers. 22

23 REFERENCES Brown, M. V., Flint, M., & Fuqua, J. (2014). The Effects of a Nutrition Education Intervention on Vending Machine Sales on a University Campus. Journal of American College Health, 62(7), Burnett, K. (2013). Students' perspectives of an urban university nutrition environment: A qualitative approach (Unpublished master's thesis). University of Alabama at Birmingham. Retrieved June 10, 2016, from Byrd-Bredbenner, C., Johnson, M., Quick, V. M., Walsh, J., Greene, G. W., Hoerr, S.,... Horacek, T. M. (2012). Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US postsecondary institution campuses. Appetite, 58(3), French, S. A., Hannan, P. J., Harnack, L. J., Mitchell, N. R., Toomey, T. L., & Gerlach, A. (2010). Pricing and availability intervention in vending machines at four bus garages. Journal of occupational and environmental medicine/american College of Occupational and Environmental Medicine, 52(Suppl 1), S29. French, S. A., Jeffery, R. W., Story, M., Breitlow, K. K., Baxter, J. S., Hannan, P., & Snyder, M. P. (2001). Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study. American Journal of Public Health, 91(1), 112. Kruger, J., Yore, M. M., Bauer, D. R., & Kohl III, H. W. (2007). Selected barriers and incentives for worksite health promotion services and policies.american Journal of Health Promotion, 21(5), Nemours Health and Prevention Services. (2010). Healthy Vending Guide. Retrieved May 17, 2016, from lthyvending.pdf Public Health Law Center (PHLC). (n.d.). Healthy Vending and the Randolph Sheppard Act. Retrieved May 16, 2016, from 23

24 APPENDIX A: UNLV VENDING USER SURVEY VENDING MACHINE SURVEY We are conducting a survey about vending machines. This survey should take less than 5 minutes to complete. If you are uncomfortable answering a question, please check Skip. Thank you for your input! 1. Age: Skip 2. Gender: Male Female Other Skip 3. Race: Select all that apply. American Indian/Alaska Native Asian Black/African American Caucasian/White Hispanic/Latino Native Hawaiian or Other Pacific Islander Other: Skip 4. Role on Campus: Select all that apply. Student Academic/Administrative Faculty Staff Other: Skip 5. Do you think vending machines can be part of a healthy environment? Yes No Unsure Skip 6. Do you think that having healthier food and beverage options in vending machines can help to improve the overall health of the environment? Yes No Unsure Skip 7. Do you think that vending machines SHOULD have healthier food and beverage options to improve the overall health of the environment? Yes No Unsure Skip 8. How would you currently describe the food and beverage options available in vending machines? There are mostly healthy options There are some healthy options There are mostly unhealthy options There are only unhealthy options Unsure Skip 9. What percentage of items should be required to meet specified nutrition guidelines for a vending machine to be categorized as healthy? 100% Over half. 50% Under half. None. Unsure Skip 10. Would you like to see healthier food and beverage options available in vending machines? Yes No Unsure Skip 11. If there were additional healthier food and beverage options, would you be more likely to purchase something out of vending machines? Yes Maybe No Unsure Skip TURN OVER TO COMPLETE 24