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Brief Report

The Effects of a Nutrition Education Intervention on Vending Machine Sales

on a University Campus

Mary V. Brown, PhD, CHES; Matthew Flint, PhD; James Fuqua, BS

Abstract. Objective: To determine the effects of a nutrition infor- mation intervention on the vending machine purchases on a col- lege campus. Participants and Methods: Five high-use vending machines were selected for the intervention, which was conducted in the fall of 2011. Baseline sales data were collected in the 5 machines prior to the intervention. At the time of the intervention, color-coded stickers were placed near each item selection to iden- tify less healthy (red), moderately healthy (yellow), and more healthy (green) snack items. Sales data were collected during the 2-week intervention. Results: Purchases of red- and yellow-stick- ered foods were reduced in most of the machines; moreover, sales of the green-stickered items increased in all of the machines. Conclusions: The increased purchases of healthier snack options demonstrate encouraging patterns that support more nutritious and healthy alternatives in vending machines.

Keywords: college students, nutrition intervention, vending machines

A s college students transition from home life to col-lege life, often there are nutrition and food chal-lenges that students may be dealing with for the first time.1 These new dietary behaviors often contribute to

the establishment of a life time of either healthy or

unhealthy behaviors.2 In a national college survey, 34.1%

of college students described themselves as overweight or

obese.3 Although obesity is a complex issue with a variety

of causes, nutrition and physical activity play a vital role in

managing energy imbalance.4

In an effort to reduce the obesity epidemic, the Centers

for Disease Control and Prevention developed the Common

Community Measures for Obesity Prevention Project,5

which was initiated to identify and recommend strategies

related to obesity prevention. The first of 24 strategies rec-

ommended healthier food and beverage choices be made

available in schools and public service venues.5 More

recently, the National Prevention Strategy unveiled in June

2011 recommended that early learning centers, schools,

colleges, and universities “implement and enforce policies

that increase availability of healthy foods, including in a la

carte lines, school stores, vending machines, and fund-

raisers.”6(p36) In addition, the Affordable Care Act now

requires calorie declarations posted near items in vending

machines, with the hope that consumers will make healthier

choices.7

Several North American school districts have developed

vending machine policies that have been implemented at

the elementary and secondary school level.8–12 Policies

ranged from turning off machines during the lunch period8

or limiting accessibility to vending machines,9,10,12

decreasing the availability of unhealthy foods, increasing

availability of healthier foods,8 and ensuring foods meet

specific nutritional standards.12 Few college campuses have

nutrition policies regarding healthy vending.

Vending machines on college and university campuses

are big business. In 2012, approximately 6.6% of the 19.31

billion dollar vending industry were from the university

and college settings.13 One study that tracked meal and

snacking patterns of university students found that 74% of

Scottish students bought food and drinks from the univer-

sity vending machines.14 Students often select food based

upon convenience, taste, time, and price,2 making vending

machines a less healthy, yet quick snack.

According to the Center for Science in the Public Inter-

est, as reported in The Nation’s Health, in a survey of 251

Dr Brown, Dr Flint, andMr Fuqua are with the Department of Public and Community Health at Utah Valley University in Orem, Utah.

Copyright � 2014 Taylor & Francis Group, LLC

512

JOURNAL OFAMERICAN COLLEGE HEALTH, VOL. 62, NO. 7

schools, 73% of beverage options and 83% of snack options

were of poor nutritional quality.15 In a study of 11 US col-

lege campuses, researchers found that the majority of bev-

erages and snacks were low in fiber, and high in calories,

fat, and sugar.16

Several interventions have been implemented in vari-

ous settings to increase the purchase of nutritious food

in vending machines. For example, increasing the num-

ber of nutrient-dense snacks and including nutrition

information resulted in a decrease in sales on one uni-

versity campus.17 Educational materials including labels

and signs placed on vending machines located in

teacher’s lounges on elementary and middle school cam-

puses promoting low-fat items increased the sale of the

healthier items, but did not reach statistical signifi-

cance.18 Another intervention included environmental pol-

icies such as eliminating regular soda beverages and

decreasing the hours of vending machine operation, which

resulted in a decrease in revenue and commissions in one

school district.8 In addition, providing healthy vending

choices and nutrition information in the worksite19 as well

as the health care setting20 has increased as consumers

demand healthier options. The results of these studies

became the impetus for this study.

This study aimed to determine the effects of a simple

nutrition information intervention on the vending

machine purchases on a college campus. The “Navigate

the Snack Debate” intervention was developed by a

group of undergraduate public and community health

students as an engaged-learning project. Our hypothesis

was that our intervention would increase the purchase of

healthy foods and decrease unhealthy foods purchased

at the vending machine.

METHODS

This study was conducted at a large western public uni-

versity with a student population of 32,000. Although the

Institutional Review Board was contacted, approval was

not necessary to collect data regarding the sales of food

items in the vending machine. The university Dining Serv-

ices Director selected 5 snack vending machines out of the

22 machines (22.7%) on campus. The 5 machines that were

selected were in high-traffic areas and considered “high

use” by Dining Services (one was located in the library, 2

in the Liberal Arts Building, and 2 in the Physical Educa-

tion Building). The unrefrigerated vending machines held

between 35 to 40 snack items each. Prior to the start of the

study, each of the food items in the vending machines were

assessed for their calories, total fat, and saturated fat based

upon the nutrition label. The nonexperimental pretest/post-

test design included a 2-week baseline period that tracked

the sales from all 5 of the machines. All data were collected

early in the fall semester to avoid any special activities (fall

break, basketball season) that might have an impact on

vending sales.

Intervention

Following the baseline data collection period, each item

received a color-coded sticker based upon the “traffic light”

system of red, yellow, or green. Criteria for the color code

was developed using the United States Department of Agri-

culture (USDA) Dietary Guidelines for Americans 201021

and the USDA Foods of Minimal Value22 because of their

use in previous vending research23,24 as well as recommen-

dations from a registered dietitian (Annette Mica, MS, RD,

LD, e-mail communication, July 2011). Items that received

the red sticker contained more than 250 calories per serving

and/or more than 40% of calories from fat and/or more than

10% of the calories from saturated fat. The yellow-stick-

ered items contained less than 250 calories, but had 30%–

39% calories from fat and/or 5%–9% of calories from satu-

rated fat. The green-stickered items also contained less than

250 calories but had less that 30% of the calories from fat

and/or less than 5% of calories from saturated fat. Two

researchers coded the machines together to ensure accu-

racy. Although it is recognized that these nutritional criteria

are not all encompassing, for example, sodium, fiber, and

sugar were not taken into account, the criteria do provide a

basis for selection categorization. Moreover, healthier fats

such as nuts were still given a red sticker because of the

high calorie count. This corresponds with the Nutrition

Environmental Measures Survey tool, which also places

nuts in the red category.25

In addition to the colored sticker placed next to the food

item in the vending machine, a vinyl sticker approximately

8 by 12 inches was posted on the front panel of each vend-

ing machine, just above the selection button. The vinyl

sticker explained what the 3 color-coded stickers indicated

and gave the brief nutrition information about each colored

sticker. Finally, 11- by 14-inch posters developed by public

health students and the university marketing department

were placed around campus encouraging students to select

the green colored items with a slogan of “Go ahead, eat and

enjoy.” The yellow colored items stated “Caution, eat mod-

erately,” whereas the red color indicated “Stop, eat

sparingly.”

Once the educational materials were in place, the sales of

each item were then tracked for an additional 2 weeks. Dur-

ing this time frame, the number of red-, yellow-, and green-

coded items remained consistent. As the data were col-

lected, the number of sales for each food item was input

into an Excel spreadsheet.

Data Analysis

Data were analyzed using the Statistical Package for

Social Sciences (SPSS) version 19.0 for Windows (SPSS,

Chicago, Illinois). A paired-sample t test was used to mea-

sure sales in each of the 5 vending machines comparing

baseline sales to intervention sales. A paired-sample t test

determines differences in means and whether they are sig-

nificant.26 A significant difference in means can indicate

Nutrition Education Intervention and Vending Machine Sales

VOL 62, OCTOBER 2014 513

T A B L E 1 . D e s c ri p ti o n s o f C a te g o ri z e d F o o d It e m s , M a c h in e s (M

– N o s .) , a n d th e P re

(B a s e ) a n d P o s t (I n t) S a le s N u m b e rs

F o o d ca te g o ry

M 1 -B as e

M 1 -I n t

M 2 -B as e

M 2 -I n t

M 3 -B as e

M 3 -I n t

M 4 -B as e

M 4 -I n t

M 5 -B as e

M 5 -I n t

T o ta l

sa le s B as e

T o ta l

sa le s In t

P er ce n t

ch an g e

C h ip s

1 5 8

1 6 2

1 0 5

7 3

1 9 7

2 0 5

2 3 3

2 8

2 8

S n ac k cr ac k er s

7 1

1 1 1

6 5

6 6

8 1

7 9

1 4 5

1 8

1 7

C o o k ie s/ C ak es

1 2 7

1 3 3

1 3 2

1 2 9

2 1 1

1 8 9

1 9

3 8

7 5

7 3

N u ts /T ra il m ix /S al am

i 4 9

4 1

5 4

3 9

1 0 9

9 4

4 1 7

6 4

3 4

C h o co la te ca n d y b ar s

1 7 3

1 3 8

1 7 0

9 9

2 0 9

1 9 9

1 0 5

8 8

N /A

N /A

N o n ch o co la te ca n d y

2 2

1 6

2 4

1 9

4 8

2 5

0 1 2

1 2

1 8

R ed

to ta ls

6 0 0

6 0 1

5 5 0

4 2 5

8 5 5

7 9 1

1 3 1

2 3 3

1 9 7

1 7 0

2 ,3 3 0

2 ,2 2 0

¡4 .4 8

S n ac k cr ac k er s

2 0

1 5

5 7

2 4

2 8

3 6

1 1 5

3 2

1 7

G ra n o la ty p e b ar s

2 2

1 6

N /A

N /A

4 3

3 4

1 1 7

2 6

2 3

N o n ch o co la te ca n d y

1 6

2 4

N /A

N /A

3 6

1 9

2 7

2 2

N /A

N /A

Y el lo w to ta ls

5 8

5 5

5 7

2 4

1 0 7

8 9

2 9

5 4

5 8

4 0

3 0 9

2 6 2

¡1 5 .2 1

S n ac k cr ac k er s/ P re tz el

3 9

6 5

4 3

1 0 0

3 1

5 4

1 7

4 3

3 5

5 5

G ra n o la ty p e b ar s

4 2

6 8

4 0

4 4

4 4

4 6

1 8

3 3

4 4

4 9

F ru it sn ac k s

3 2

2 9

3 5

2 6

2 4

4 5

1 1 7

1 8

2 4

G re en

to ta ls

1 1 3

1 6 2

1 1 8

1 7 0

9 9

1 4 5

3 6

9 3

9 7

1 2 8

4 6 3

6 9 3

C5 0 .7 6

N o te . N /A

in d ic at es

fo o d it em

s w er e n o t so ld

in a p ar ti cu la r m ac h in e.

Brown, Flint, & Fuqua

514 JOURNAL OFAMERICAN COLLEGE HEALTH

that the intervention did have an influence on behaviors, in

this case the purchasing behaviors of college students

toward healthy and unhealthy food choices.

RESULTS

Table 1 shows descriptions of the categories of food

items, the machine numbers (M- nos.), and the baseline

sales compared with the intervention sales as well as the

percent change in total sales. The data show that some of

the items increased or decreased after the intervention,

depending on the machine and the item. For example, the

purchases of red-stickered foods in vending machine M2,

M3, and M5 were reduced. In addition, all of the machines

except M4 also had reduced sales of the yellow-labeled

food items. Moreover, the purchases for the green-labeled

items increased in all the machines following the interven-

tion. In total, there was a decrease in the sale of red-stick-

ered items of 113 (4.84%), as well as a decrease of 47

(15.21%) yellow-stickered items from baseline to after the

intervention. There was an increase in the sale of green-

stickered items of 235 (50.76%) from baseline to after the

intervention.

Results of the paired-sample t test analysis on the snack

items purchased before the intervention and after the inter-

vention demonstrated that there was one significant change

in consumer preferences after the intervention, p < .05,

with Cohen’s d effect size r D ¡.14 in machine M4, with the green category items. Although there were large differ-

ences seen in the purchasing of certain items, there were no

significant differences in the purchases of the red and yel-

low category items across any of the 5 vending machines

after the intervention.

COMMENT

Accepting this study’s limitations, there are some impli-

cations for future research being done in this area. First,

more research is needed regarding the controlling of envi-

ronmental triggers, such as vending machines and their con-

tents, and what choices are made by individuals and/or

groups. The hypothesis that if all vending machines on col-

lege campuses only offered healthy foods then purchases

would dramatically decrease needs to be assessed through

well-controlled studies.

In addition, larger studies are needed that compare food

choices from not only more vending machines at one cam-

pus, but between multiple campuses. Further research is

needed that explores whether special events on campus

increase or decrease healthy or unhealthy food choices. In

the case of the current study, there were no special events

during the study’s time frame.

Limitations

Limitations of this study include a small sample size,

with only 5 vending machines on one university campus.

Although the study originally was designed to utilize 10

machines across campus with a longer intervention period,

restrictions from the university Dining Services made it

necessary to reduce the number of machines as well as the

intervention length.

Conclusions

The purpose of this study was to determine the impact of

a simple nutrition education intervention on the purchase of

healthy versus unhealthy food in vending machines on a

university campus. There is evidence that environmental

changes, such as offering a greater variety of healthier

foods and reducing the less healthy foods17,27 as well as

pricing strategies such as lowering the price of healthier

items28 and increasing the price of less healthy items,20 can

have a positive effect on healthier vending machine

choices.

Although these interventions have proven effective in the

past, health professionals face challenges, especially if they

lack support from stakeholders. Early communication with

Dining Services, specifically vending staff, may have

resulted in a longer, more effective intervention. Also, fear

of reduced vending sales and lost revenue8 may deter

schools and universities from participating in a healthy

vending program; however, this study demonstrated that

sales actually increased slightly during the intervention

period (total baseline sales were 3,105, whereas the total

intervention sales were 3,180). The total impact on sales

was an increase of 75 items (2.41%).

Public health strategies to create a “culture of health”

may be one piece to solving the epidemic of obesity. Pro-

viding a greater number of healthier options, providing ded-

icated machines with only healthy options, and utilizing

pricing strategies to encourage healthy selections were rec-

ommended to Dining Services. It is hoped that these types

of studies would encourage policy change on campus that

would foster healthier behaviors. Future studies should

examine both availability and pricing strategies to deter-

mine their effectiveness in a university setting. In addition,

the assignment of the color code may need to be adjusted to

accommodate healthier snacks (eg, almonds and other) that

may be higher in fat and calories.

FUNDING

This research was funded by the Grants for Engaged

Learning at Utah Valley University.

CONFLICT OF INTEREST DISCLOSURE

The authors have no conflicts of interest to report.

The authors confirm that the research presented in this

article met the ethical guidelines, including adherence to

the legal requirements, of the United States and received

approval from the Institutional Review Board of Utah

Valley University.

VOL 62, OCTOBER 2014 515

Nutrition Education Intervention and Vending Machine Sales

NOTE

For comments and further information, address corre-

spondence to Mary V. Brown, Utah Valley University,

Department of Public and Community Health, 800 W.

University Parkway, Orem, UT 84058, USA (e-mail:

brownma@uva.edu).

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Received: 18 March 2013 Revised: 10 March 2014 Accepted: 25 April 2014

516 JOURNAL OFAMERICAN COLLEGE HEALTH

Brown, Flint, & Fuqua

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