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Consumer support for healthy food and drink vending machines in public places

Consumer support for healthy food and drink vending machines in public places D iet‐related chronic conditions are major contributors to the burden of disease in Australia and are associated with high intakes of energy, saturated fat, sugar and salt. 1 Recent Australian population dietary data identify that around one‐third of daily energy intake comes from snacks (28% for adults and 35% for children) 2 and so the nutritional quality of snacks is an important consideration in overall diet quality. Across a variety of settings, vending machines contribute to obesogenic food environments, contributing to the availability of energy‐dense, nutrient‐poor packaged snacks and sugary drinks. 3,4 Changes to vending machines, such as introducing healthier products and having clear nutrition information available pre‐purchase, may enable consumers to make healthier choices. 5–8 In Australia, the usefulness of front‐of‐pack labelling (FOPL) formats for vending machines has not been formally evaluated; however, FOPL has been shown to be effective at enabling consumers to identify healthier choices in other contexts. 9,10 This study aimed to investigate consumers' attitudes towards the availability and cost of vended products to determine the suitability of components for a healthy vending machine intervention in two public sites. It also examined which of two FOPL systems better enabled consumers to identify healthier snack products in the vending machine context. Methods Procedures and participants Two sites, a university campus and public hospital in regional NSW, Australia, were selected for participant recruitment. The sites were selected because food and drink vending machines were present at both sites, the sites were accessible to the researchers and including both broadened the type of potential participants. Face‐to‐face surveys using questionnaires with university students (n=120) and hospital participants (n=120) were conducted following direct approaches by the researcher (AC) across multiple days and times throughout 2013. Quotas were established for an approximately equal distribution of participants identified as users (ever used) or non‐users (never purchased snacks or drinks) of vending machines. Ethics approval was provided by the University of Wollongong Research Ethics Committee (HE13/178). The questionnaire developed by the research team explored: a) use of vending machines; b) perceived healthiness of the current range of vending machine products; c) likelihood of buying possible healthier alternatives; d) willingness to pay more for healthier items; and e) perceived usefulness of FOPL for vending machines. The survey comprised a range of dichotomous (c, e); multiple choice (a, b); rank order scaling (a, c); Likert scale (d); and open‐ended questions (c, e). For FOPL testing, participants were asked to identify the healthier choice of snack in five paired food comparisons for product types typically stocked in vending machines (Table ). Participants were randomly assigned to one of the two label conditions with the roll of a die (evens = TL, odds = 3‐star system). Each product comparison was initially completed with a product image only (no nutrition information), followed by accompaniment of the image with one of the two FOPL systems tested: Traffic Light (TL) system 11 or US Institute of Medicine 3‐star system. 12 The UK Food Standards Agency's TL system contains criteria for total fat, saturated fat, sugars and sodium. High, medium and low levels of these nutrients are represented by red, amber and green colour coding. The US system awards zero to three points based on the levels of saturated fat, added sugars and sodium in a product. Product scores are represented using a star format similar to that on whitegoods in Australia. Performance testing of two front‐of‐pack labelling systems. Product pair Participants choosing healthier product without label (%) Participants choosing healthier product with label (%) p –value a Total sample (n = 240) Chocolate vs. fruit strap 71.7 91.3 < 0.001 Lollies vs. sultanas 94.2 90.4 0.124 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 68.3 94.6 < 0.001 Potato crisps vs. roasted chickpeas 82.1 90.8 0.005 Cola vs. fruit juice 83.3 72.5 0.004 Traffic Light label sample (n = 126) Chocolate vs. fruit strap 68.3 92.1 < 0.001 Lollies vs. sultanas 93.7 86.5 0.058 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 70.6 92.1 < 0.001 Potato crisps vs. roasted chickpeas 83.3 92.1 0.035 Cola vs. fruit juice 84.1 65.1 0.001 3‐star label sample (n = 114) Chocolate vs. fruit strap 75.4 90.4 0.003 Lollies vs. sultanas 94.7 94.7 1.000 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 65.8 97.4 < 0.001 Potato crisps vs. roasted chickpeas 80.7 89.5 0.063 Cola vs. fruit juice 82.5 80.7 0.733 a: Pearson's chi‐squared test Analysis Quantitative data were analysed using IBM SPSS for Windows version 19.0 (IBM Corp, 2010. Armonk, NY). Pearson's chi‐square test was used to assess differences in the proportion of participants correctly selecting the healthier product when presented with a FOPL compared to with no label. P –values less than 0.05 were considered statistically significant. Results Participants' characteristics In total (n=240), 101 males (42.1%) and 139 females (57.9%) completed the survey (response rate 86.0%). Hospital participants comprised employees (46.7%), patients (25.8%), visitors (19.2%) and other (8.3%). Attitudes towards vending machine products The majority of university (92.5%) and hospital participants (82.5%) identified the current range of snack foods as ‘too unhealthy’. The remaining 7.5% of university students perceived there to be a good range of healthy and unhealthy snack products, as did 16.7% of hospital participants. Slightly more hospital than university participants viewed the current range of beverages as too unhealthy (58.3% and 55.0%, respectively). The remaining 45.0% of students said there was a good range, as did 40.8% of hospital participants. For these two questions related to the healthiness of vending machine products, there was one hospital participant who stated that the range of both snacks and drinks was too healthy. Healthier snack options The most popular choices of healthier snack were nuts (82.7% would buy), muesli bars (73.3%) and dried fruit (62.9%). The least popular options were fruit leathers (58.3% would not buy) and roasted chickpeas (57.5%). Healthier suggestions made by participants included fresh fruit and vegetable salads, reduced fat yoghurt and microwavable soups. Health/nutrition was the most important motivating factor for determining potential purchase of a healthier vending machine product (health and nutrition n=88; taste n=70; convenience n=38). Cost Many students (46.7%) and hospital participants (40.8%) were willing to pay the same amount for healthier products as currently available snacks. Thirty‐two per cent of students and 40.0% of hospital participants were prepared to pay more for healthier vending machine items. FOPL testing There was a significant association between the presence of any FOPL and choosing the healthier product for two of the product comparisons: chocolate vs. fruit strap and cereal bar low fat/sugar vs. cereal bar high fat/sugar. There was also a significant association for participants shown the TL label for potato crisps vs. roasted chickpeas (Table ). In each instance, the proportion of participants choosing the healthier product increased with the presence of a label compared with no label. The proportion of participants choosing the healthier product for the lollies vs. sultanas and cola vs. fruit juice comparisons either did not change or decreased with the presence of either labelling system. Notably, the presence of the TL label significantly decreased the proportion of participants correctly identifying the healthier option for the beverage choice (19.0% point lower, p =0.001). Discussion Consumption of energy‐dense, nutrient‐poor foods and drinks is one factor driving the increase in population rates of overweight and obesity. 1 This study identifies that consumers are interested in initiatives to improve the nutritional quality of items available from vending machines, and about 80% are willing to pay more or the same amount for healthier products. Furthermore, providing nutrition information at the point‐of‐purchase has the potential to aid healthier snack decisions for vending machine users. The FOPL systems tested were selected prior to announcement of the Australian Health Star Rating. 13 This FOPL should be tested for its usefulness on vending machines, given that it will be the system adopted for widespread use in Australia, 13 and research indicates consumer preference for a single, consistent labelling format. 10 The observed decrease in the proportion of participants correctly identifying the healthier drink may have resulted from misunderstanding how added sugars are assessed and presented on the TL label. Participants in this study were concerned about their wellbeing, reporting health to be an important consideration when making food choices, although this may be partly influenced by social desirability biases. Nevertheless, participants' positive attitudes towards healthy vending options are supportive of previous international research that demonstrates consumer interest in healthier vending machine options. 5–8 This consumer demand must be supported by commitment from public and private sectors to make changes to food environments that will reinforce making healthy choices easy choices. 14 Creation of healthier food environments is an essential component of public health efforts to reduce levels of diet‐related disease. The results of this study demonstrate that the introduction of healthier snacks and drinks to vending machines in public places would be received positively by consumers, and provide support for making changes to product availability, promotion and labelling in this food environment. Funding sources This study was funded by a Food & Health Strategic Research Initiative Grant from the University of Wollongong, NSW, Australia. The funding was used for the purchase of vouchers provided to university students who participated in the research. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Consumer support for healthy food and drink vending machines in public places

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References (16)

Publisher
Wiley
Copyright
© 2015 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/1753-6405.12386
pmid
26122607
Publisher site
See Article on Publisher Site

Abstract

D iet‐related chronic conditions are major contributors to the burden of disease in Australia and are associated with high intakes of energy, saturated fat, sugar and salt. 1 Recent Australian population dietary data identify that around one‐third of daily energy intake comes from snacks (28% for adults and 35% for children) 2 and so the nutritional quality of snacks is an important consideration in overall diet quality. Across a variety of settings, vending machines contribute to obesogenic food environments, contributing to the availability of energy‐dense, nutrient‐poor packaged snacks and sugary drinks. 3,4 Changes to vending machines, such as introducing healthier products and having clear nutrition information available pre‐purchase, may enable consumers to make healthier choices. 5–8 In Australia, the usefulness of front‐of‐pack labelling (FOPL) formats for vending machines has not been formally evaluated; however, FOPL has been shown to be effective at enabling consumers to identify healthier choices in other contexts. 9,10 This study aimed to investigate consumers' attitudes towards the availability and cost of vended products to determine the suitability of components for a healthy vending machine intervention in two public sites. It also examined which of two FOPL systems better enabled consumers to identify healthier snack products in the vending machine context. Methods Procedures and participants Two sites, a university campus and public hospital in regional NSW, Australia, were selected for participant recruitment. The sites were selected because food and drink vending machines were present at both sites, the sites were accessible to the researchers and including both broadened the type of potential participants. Face‐to‐face surveys using questionnaires with university students (n=120) and hospital participants (n=120) were conducted following direct approaches by the researcher (AC) across multiple days and times throughout 2013. Quotas were established for an approximately equal distribution of participants identified as users (ever used) or non‐users (never purchased snacks or drinks) of vending machines. Ethics approval was provided by the University of Wollongong Research Ethics Committee (HE13/178). The questionnaire developed by the research team explored: a) use of vending machines; b) perceived healthiness of the current range of vending machine products; c) likelihood of buying possible healthier alternatives; d) willingness to pay more for healthier items; and e) perceived usefulness of FOPL for vending machines. The survey comprised a range of dichotomous (c, e); multiple choice (a, b); rank order scaling (a, c); Likert scale (d); and open‐ended questions (c, e). For FOPL testing, participants were asked to identify the healthier choice of snack in five paired food comparisons for product types typically stocked in vending machines (Table ). Participants were randomly assigned to one of the two label conditions with the roll of a die (evens = TL, odds = 3‐star system). Each product comparison was initially completed with a product image only (no nutrition information), followed by accompaniment of the image with one of the two FOPL systems tested: Traffic Light (TL) system 11 or US Institute of Medicine 3‐star system. 12 The UK Food Standards Agency's TL system contains criteria for total fat, saturated fat, sugars and sodium. High, medium and low levels of these nutrients are represented by red, amber and green colour coding. The US system awards zero to three points based on the levels of saturated fat, added sugars and sodium in a product. Product scores are represented using a star format similar to that on whitegoods in Australia. Performance testing of two front‐of‐pack labelling systems. Product pair Participants choosing healthier product without label (%) Participants choosing healthier product with label (%) p –value a Total sample (n = 240) Chocolate vs. fruit strap 71.7 91.3 < 0.001 Lollies vs. sultanas 94.2 90.4 0.124 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 68.3 94.6 < 0.001 Potato crisps vs. roasted chickpeas 82.1 90.8 0.005 Cola vs. fruit juice 83.3 72.5 0.004 Traffic Light label sample (n = 126) Chocolate vs. fruit strap 68.3 92.1 < 0.001 Lollies vs. sultanas 93.7 86.5 0.058 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 70.6 92.1 < 0.001 Potato crisps vs. roasted chickpeas 83.3 92.1 0.035 Cola vs. fruit juice 84.1 65.1 0.001 3‐star label sample (n = 114) Chocolate vs. fruit strap 75.4 90.4 0.003 Lollies vs. sultanas 94.7 94.7 1.000 Cereal bar low fat/sugar vs. cereal bar high fat/sugar 65.8 97.4 < 0.001 Potato crisps vs. roasted chickpeas 80.7 89.5 0.063 Cola vs. fruit juice 82.5 80.7 0.733 a: Pearson's chi‐squared test Analysis Quantitative data were analysed using IBM SPSS for Windows version 19.0 (IBM Corp, 2010. Armonk, NY). Pearson's chi‐square test was used to assess differences in the proportion of participants correctly selecting the healthier product when presented with a FOPL compared to with no label. P –values less than 0.05 were considered statistically significant. Results Participants' characteristics In total (n=240), 101 males (42.1%) and 139 females (57.9%) completed the survey (response rate 86.0%). Hospital participants comprised employees (46.7%), patients (25.8%), visitors (19.2%) and other (8.3%). Attitudes towards vending machine products The majority of university (92.5%) and hospital participants (82.5%) identified the current range of snack foods as ‘too unhealthy’. The remaining 7.5% of university students perceived there to be a good range of healthy and unhealthy snack products, as did 16.7% of hospital participants. Slightly more hospital than university participants viewed the current range of beverages as too unhealthy (58.3% and 55.0%, respectively). The remaining 45.0% of students said there was a good range, as did 40.8% of hospital participants. For these two questions related to the healthiness of vending machine products, there was one hospital participant who stated that the range of both snacks and drinks was too healthy. Healthier snack options The most popular choices of healthier snack were nuts (82.7% would buy), muesli bars (73.3%) and dried fruit (62.9%). The least popular options were fruit leathers (58.3% would not buy) and roasted chickpeas (57.5%). Healthier suggestions made by participants included fresh fruit and vegetable salads, reduced fat yoghurt and microwavable soups. Health/nutrition was the most important motivating factor for determining potential purchase of a healthier vending machine product (health and nutrition n=88; taste n=70; convenience n=38). Cost Many students (46.7%) and hospital participants (40.8%) were willing to pay the same amount for healthier products as currently available snacks. Thirty‐two per cent of students and 40.0% of hospital participants were prepared to pay more for healthier vending machine items. FOPL testing There was a significant association between the presence of any FOPL and choosing the healthier product for two of the product comparisons: chocolate vs. fruit strap and cereal bar low fat/sugar vs. cereal bar high fat/sugar. There was also a significant association for participants shown the TL label for potato crisps vs. roasted chickpeas (Table ). In each instance, the proportion of participants choosing the healthier product increased with the presence of a label compared with no label. The proportion of participants choosing the healthier product for the lollies vs. sultanas and cola vs. fruit juice comparisons either did not change or decreased with the presence of either labelling system. Notably, the presence of the TL label significantly decreased the proportion of participants correctly identifying the healthier option for the beverage choice (19.0% point lower, p =0.001). Discussion Consumption of energy‐dense, nutrient‐poor foods and drinks is one factor driving the increase in population rates of overweight and obesity. 1 This study identifies that consumers are interested in initiatives to improve the nutritional quality of items available from vending machines, and about 80% are willing to pay more or the same amount for healthier products. Furthermore, providing nutrition information at the point‐of‐purchase has the potential to aid healthier snack decisions for vending machine users. The FOPL systems tested were selected prior to announcement of the Australian Health Star Rating. 13 This FOPL should be tested for its usefulness on vending machines, given that it will be the system adopted for widespread use in Australia, 13 and research indicates consumer preference for a single, consistent labelling format. 10 The observed decrease in the proportion of participants correctly identifying the healthier drink may have resulted from misunderstanding how added sugars are assessed and presented on the TL label. Participants in this study were concerned about their wellbeing, reporting health to be an important consideration when making food choices, although this may be partly influenced by social desirability biases. Nevertheless, participants' positive attitudes towards healthy vending options are supportive of previous international research that demonstrates consumer interest in healthier vending machine options. 5–8 This consumer demand must be supported by commitment from public and private sectors to make changes to food environments that will reinforce making healthy choices easy choices. 14 Creation of healthier food environments is an essential component of public health efforts to reduce levels of diet‐related disease. The results of this study demonstrate that the introduction of healthier snacks and drinks to vending machines in public places would be received positively by consumers, and provide support for making changes to product availability, promotion and labelling in this food environment. Funding sources This study was funded by a Food & Health Strategic Research Initiative Grant from the University of Wollongong, NSW, Australia. The funding was used for the purchase of vouchers provided to university students who participated in the research.

Journal

Australian and New Zealand Journal of Public HealthWiley

Published: Aug 1, 2015

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