Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages: A Randomized Trial.

Importance: Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. Objective: To examine which of 4 food and beverage messages would increase healthier vending machine purchases. Design, Setting, and Participants: This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Interventions: Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Main Outcomes and Measures: Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Results: Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. Conclusions and Relevance: In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. Trial Registration: ClinicalTrials.gov Identifier: NCT06260176.

Effects of traffic light labelling and increased healthy range on beverage choices from vending machines.

OBJECTIVE: To test whether traffic light labels and an increased range of healthy beverages, individually and in combination, can increase healthy beverage choices from vending machines. DESIGN: Two studies (n 558, 420) tested whether the provision of traffic light labels (green, amber and red) and an increased range of healthy beverages (from 20 % to 50 % green options), individually and in combination, could increase healthy beverage choices from a digital vending machine display. The studies used a between-subjects experimental design, and a hypothetical beverage choice, a limitation when considering real-world applicability. SETTING: Both studies utilised an online Qualtrics survey that featured a digital vending machine display. PARTICIPANTS: Both studies (n 558, 420) consisted of university students from Flinders University and individuals from a survey recruitment service. RESULTS: Featuring traffic lights did not significantly influence beverage choices (P = 0·074), while increasing the healthy range (P = 0·003, OR = 3·27), and the combination of both, did significantly increase healthier beverage choices (P < 0·001, OR = 4·83). CONCLUSIONS: The results suggest that the traffic light system and increased healthy range are not maximally effective when used on their own, and benefit greatly when combined, to increase healthy beverage choices. It was suggested that the provision of traffic light labels supplied the necessary nutritional information, and the increased healthy range offered greater opportunity to act in accordance with that information. In so doing, the present findings offer a promising pathway for reducing unhealthy beverage consumption.

Evaluating source credibility effects in health labelling using vending machines in a hospital setting.

OBJECTIVES: Providing advice to consumers in the form of labelling may mitigate the increased availability and low cost of foods that contribute to the obesity problem. Our objective was to test whether making the source of the health advice on the label more credible makes labelling more effective. METHODS AND MEASURES: Vending machines in different locations were stocked with healthy and unhealthy products in a hospital. Healthy products were randomly assigned to one of three conditions (i) a control condition in which no labelling was present (ii) a low source credibility label, "Lighter choices", and (iii) a high source credibility label that included the UK National Health Service (NHS) logo and name, "NHS lighter choices". Unhealthy products received no labelling. The outcome measure was sales volume. RESULTS: There were no main effects of labelling. However, there were significant interactions between labelling, vending machine location and payment type. For one location and payment type, sales of products increased in the high credibility label condition compared to control, particularly for unhealthy products, contrary to expectations. CONCLUSIONS: Our findings suggest that high source credibility health labels (NHS endorsement) on food either have little effect, or worse, can "backfire" and lead to effects opposite to those intended. The primary limitations are the limited range of source credibility labels and the scale of the study.

Evaluation of an experiment to increase availability of healthier snack foods in vending machines situated within English sports facilities.

OBJECTIVE: To evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres. DESIGN: An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase the availability of healthier options, using agreed nutrition criteria - Government Buying Standards for Food and Catering Services (GBSF) for England - as a guide, as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories. SETTING: Fifteen sports centres in the city of Leeds, West Yorkshire, UK. PARTICIPANTS: Snack products sold in eighteen vending machines. RESULTS: Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47·25 MJ (95 % CI (-61·22, -33·27)) per machine and by 279 kJ, (95 % CI (-325, -266)) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention. CONCLUSIONS: Introducing standards to increase availability of healthier snack products in vending machines is feasible without substantially affecting sales.

Encrucijadas sobre ¿qué vender?: máquinas expendedoras en entornos alimentarios universitarios / Crossroads about what to sell?: vending machines in university food environments

Introducción. Las máquinas expendedoras de bebidas y alimentos (MEBA) ganan presencialidad en universidades, lo que potencia aumento de peso en adultos jóvenes. Objetivo. reconocer la configuración de las MEBA para la construcción del ambiente alimentario saludable en una universidad de Colombia. Materiales y métodos. Diseño descriptivo multimodos, con aproximación empírica de: entrevista a tomadores de decisión (n=6) de la institución educativa; análisis de ventas durante un año (n=12.955) en las MEBA (n=12); caracterización por densidad nutricional de la oferta (n=152) y rastreo a comunicaciones circulantes asociadas con alimentación. El análisis consideró cuatro momentos: I-Relaciones; II-Canal MEBA; III-Nutrición y IV-Interacción. Los I y II se enfocaron en los componentes político, sociocultural, físico y económico. El III estudió el aporte nutricional de bebidas y alimentos para integrar resultados en el IV. Resultados. La ausencia de política sobre alimentación institucional como la visibilización comunicativa parecen potenciar condiciones sociales que refuerzan lógicas de: "mal necesario", "perfil de consumo ya existente", "ausencia de ejercicios académicos" y "experiencias negativas con alimentación saludable". Cimientos para ofertar con mayor demanda bebidas como refrescos y agua y, en alimentos, chocolate en diferentes formulaciones. En la clasificación por densidad nutricional se encontró que las bebidas fueron clasificadas como "no saludable" (51,6%); "algo saludable" (28,1%) y "saludable" (20,3%). Los alimentos "algo saludable" (44,9%); "no saludable" (32,2%) y "saludable" (22,9%). Conclusiones. la universidad, espacio de formación, requiere realizar esfuerzos de comprensión sociocultural, gerencia alineada a normativas de promoción de salud para incidir en la calidad nutricional ofertada a la comunidad universitaria(AU)

Introduction. Food and beverage vending machines (MEBA) are gaining presence in universities, which promotes weight gain in young adults. Objective. to recognize the configuration of the MEBA for the construction of a healthy food environment in a university in Colombia. Materials and methods. multimodal descriptive design, with an empirical approach of: interview with decision makers of the educational institution (n=6); analysis of sales during one year (n=12,955) in the MEBAs (n=12); characterization by nutritional density of the offer (n=152) and tracking of circulating communications associated with food. The analysis considered four moments: I-Relationships; II-MEBA Channel; III-Nutrition and IV-Interaction. I and II focused on the political, sociocultural, physical and economic components. The III studied the nutritional contribution of drinks and foods to integrate results in the IV. Results. the absence of a policy on institutional food such as communicative visibility seems to enhance social conditions that reinforce logics of: "necessary evil", "already existing consumption profile", "absence of academic exercises" and "negative experiences with healthy eating". Foundations to offer with greater demand drinks such as soft drinks and water and, in food, chocolate in different formulations. In the classification by nutritional density, it was found that the drinks were classified as "unhealthy" (51.6%); "something healthy" (28.1%) and "healthy" (20.3%). "Somewhat healthy" foods (44.9%); "unhealthy" (32.2%) and "healthy" (22.9%). Conclusions. the university, a training space, requires efforts at sociocultural understanding, management aligned with health promotion regulations to influence the nutritional quality offered to the university community(AU)

A Cross-Sectional Evaluation of the Food Environment at an Australian University Campus.

University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework ('Framework'), which assesses food environment parameters including the availability, placement, and promotion of 'Everyday' (healthy) and 'Occasional' (less healthy) products. Each parameter was evaluated overall and across each food outlet type. Across all outlets, Everyday foods and drinks made up 43.9% of all products. Only two outlets met the Framework's product availability benchmark of ≥75% Everyday foods and drinks. A total of 43 outlets (84.3%) sold sugary drinks as part of their product range. Occasional products made up 68.4%, 53.3%, and 59.9% of all items for sale at checkout areas, countertops, and eye-level shelves, respectively. Finally, 79.7% of meal deals included Occasional products. Our findings highlight the need to improve the availability, placement, and promotion of foods and drinks sold at a major university campus in Sydney, Australia.

Preliminary Investigation on Hygienic-Sanitary Quality of Food Vending Machines.

The consumption of hot drinks dispensed from vending machines has become a common practice, both in workplaces and during free time. Every day, millions of bulk drinks are sold, but the quality of the products distributed may not always be guaranteed, as it is related to many factors such as the quality of the water, the raw materials used, and the effectiveness of the equipment's cleaning system. The purpose of this study is to evaluate the hygienic-sanitary requirements of hot drinks and vending machine surfaces. The investigation highlighted the microbial contamination of both coffee and vending machine surfaces. Although the "coffee break" is usually considered a moment of pleasure, apparently not subject to specific jurisdiction, the products dispensed can represent a health risk if the hygienic conditions are not fully respected. Therefore, official controls carried out by the Prevention Department represent a suitable way for evaluating and guaranteeing the hygienic-sanitary requirements, providing for corrective actions, when needed, to protect consumers.

Developing, Implementing, and Evaluating a Campus-Wide Pharmacy Vending Machine Program.

Lack of access to affordable, accessible, over-the-counter medications and health-related items affects school attendance, academic performance, and individual health. Increasing access through innovations, such as Pharmacy Vending Machines (PhVMs), may address the burdens students face in university settings. In January 2021, two PhVMs were placed on Purdue University's campus to increase access to affordable and dependable 24/7 family planning items, cold/flu remedies, and other popular over-the-counter pharmaceuticals. Based on the success of the initiative and growing student body, the program was expanded to include two additional machines in August 2021. In this article, we detail how Purdue University planned, implemented, and evaluated a campus-wide PhVM program, which was an interdisciplinary collaboration across students, faculty, and staff in the College of Health and Human Sciences and College of Pharmacy. Pharmaceutical product availability in convenient vending machines dispersed throughout a campus contributes to a solution for the increasing demand for health products among consumers in large geographic areas.

Impact of Smart Snacks Intervention on College Students' Vending Selections.

OBJECTIVES: To place Smart Snacks in vending machines and determine if different sales strategies affect Smart Snack selection. PARTICIPANTS: University students living in resident halls. METHODS: Vending machines included 50% Smart Snacks and 50% non compliant snacks. Three sales strategies targeted student selection of Smart Snacks: Reduced price, signage, and nutrition education activities. Three-way ANOVA was used for analysis. RESULTS: There was a statistically significant three-way interaction on snack selection between sales strategy, study period, and snack type, F(4, 77) = 3.33, P = .01. There were no statistically significant simple two-way interaction between study period and sales strategy for either Smart Snack, F(1, 77) = 1.62, P = 0.18, or NC snack types, F(1, 77) = 2.02, P = 0.07. CONCLUSIONS: Sales strategies did not affect Smart Snack selections. Advocates for healthier snacks in vending machines can align with university administrations to establish nutrient guidelines.

Assessment of Nutritional Quality of Products Sold in University Vending Machines According to the Front-of-Pack (FoP) Guide.

The aim of this research was to assess the nutritional composition of 654 foods and beverages from vending machines on a University Campus. The guide called "Creating a front of pack nutrition label for pre-packed products sold through retail outlets" from the Department of Health (UK) was used to assess the nutritional composition and to compare values from food and beverage categories. A high proportion of food items had high−moderate content of nutrients related to chronic disease (93, 88, 74 and 49% had high−moderate content of fat, saturated fat, salt and sugar, respectively). On the other hand, a few beverages had high−moderate content of these nutrients, except for sugar (2% high to moderate in fat, 2% in saturated fat, 0% in salt and 39% in sugar). The most frequent food categories were chocolates and bars (10.6%) and breadsticks (8.4%), whereas the most available beverages were water (27.7%) and soft drinks (23.4%). There were no statistically significant differences in the proportion of categories between the health science and humanities faculties, except for energy drinks (p < 0.05) and soft drinks (p < 0.05). Vending machines contribute to an obesogenic environment and do not support healthy snacking. Recommendations in this article should be considered to develop official guidelines to ensure the wider availability of healthy dietary choices in vending machines in university settings.

Factors That "Nudge People towards the Healthier" Snacks-A Qualitative Study with Student, Faculty, and Staff Leaders and Decision Makers.

(1) College campuses pose numerous public health challenges for students, faculty and staff. The healthfulness of the snacks available on campuses is lacking, and there is a desire for change among the students and staff. The objective of this study is to understand the perspectives of the students, staff, and decision makers regarding the college campus food environment and the perceived facilitators and barriers to improving it. (2) In-depth interviews were conducted (n = 15) with decision makers in food, policy development, wellness, and nutrition at a large Hispanic-Serving University in South Florida. (3) The key stakeholders shared that educational campaigns, student buy-in, raising awareness around obesity and chronic disease, and the university's position within the community would all help to facilitate improvements to the snack food environment. However, the participants noted that the complex nature of what is considered to be healthy and what divergent consumers want are significant barriers to improving the snack food environment along with concerns over lost revenue and the corporate structure. (4) These results inform potential focal points for multi-level interventions and inform policy discussions focused on improving the snack food environment at minority-serving universities. Taking strategic actions to improve the snack food environment may aid the students and staff of the university to enhance their diet quality.

On-campus food purchase behaviors, choice determinants, and opinions on food availability in a Spanish university community.

OBJECTIVE: The aim of this study was to investigate food purchasing behaviors, choice determinants, and opinions about on-campus food availability by a university community and to analyze differences in these aspects between students, education and/or research staff (ERS), and administrative and services staff (ASS), and between males and females. METHODS: This was a cross-sectional study that involved a representative sample of students (n = 1089), ERS (n = 396), and ASS (n = 300) who completed an anonymous online survey. A previously adapted version of the questionnaire was administered. The results were weighted to ensure representativeness of this community population using weighted coefficients. RESULTS: The results showed that most of the participants purchased food on campus (91.6%), especially for lunch (67.4% of foods and 37.4% of drinks) and snack (65.4% of foods and 45.4% of drinks). Hot drinks (i.e., coffee, tea, hot chocolate etc.; 60.5%), bottled water (49.2%), and hot foods (i.e., small servings [38.2%] and sandwiches/hamburgers [31.7%]) were the most purchased items. Taste (98.6%) was the most important determinant in choice, followed by price for students, nutritional value for ASS, and health value for ERS. The "top 5" opinions suggested for the campus food environment and potential changes were "greater capacity to access free filtered drinking water", "greater capacity to recycle food packaging," "more healthy options in vending machines", "discounts for healthy choices," and "allergen labeling." CONCLUSION: Interventions that improve sustainability and the affordability of products with high nutritional quality, price-manipulation directives, and allergen information on labeling would be well received among this community.

Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops.

PURPOSE: Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments. DESIGN: Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region. MEASURES: Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units. ANALYSIS: Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann-Whitney U, χ2, or Fisher's exact test as appropriate. RESULTS: Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (-45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (-33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (-6 to 55 range) and 2.9 ± 4.0 (-6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported. CONCLUSION: Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.

On-campus food environment, purchase behaviours, preferences and opinions in a Norwegian university community.

OBJECTIVE: To assess the food environment at OsloMet, through the nutritional profile and processing level of available commercial foods and drinks, as well as to determine food-purchasing behaviours, preferences and opinions on the food environment, in order to identify whether interventions on campus need to be conducted. DESIGN: Cross-sectional descriptive study. SETTING: Pilestredet and Kjeller campus of OsloMet (Norway). PARTICIPANTS: To analyse the nutritional profile of products offered at all food outlets (seven canteens, three coffee shops and two vending machines) at the main campuses three criteria were applied: those proposed by the Spanish Agency for Food Safety and Nutrition, the UK nutrient profiling model and those of the Food and Drink Industry Professional Practices Committee Norway. In addition, products were classified by processing level, using the NOVA system. Food purchasing, food choice behaviours and opinions were analysed through a survey online, in which 129 subjects participated. RESULTS: With regard to the first of the objectives, the combination of the above-mentioned criteria showed that 39·8 % of the products were 'unhealthy' and 85·9 % were 'ultra-processed'. Regarding the second objective, the most important determinants of food choice were taste, convenience, and cost and nutrition/health value. The most common improvements suggested were lowering the cost, improving the allergen information on labelling and increasing the variety of fresh and healthy foods. CONCLUSIONS: A high proportion of the products offered were considered 'unhealthy' and highly processed. Interventions that improve food prices, availability and information on labelling would be well-received in this community.

Do products from healthier vending machines on a university campus sell?

ObjectiveThis is a cross-sectional study that compares the sales of "healthy" and "unhealthy" vending machines following the introduction of healthier vending machines on a university campus. Method: Healthy ("green" and "amber" category), competitively priced snacks and beverages in vending machines (n = 4) called Grab Goodness were placed alongside standard vending machines (n = 11). The monthly sales data from all vending machines were captured electronically for 20 months. Results: Assortment of snacks and beverages offered by standard vending machines were of low nutritional quality, with only 16% of all products categorized as "green." The new Grab Goodness machines accounted for 28% of all vending machine purchases over 20 months, and 50% of all products purchased through these machines were "green" category items. Conclusions: The purchases of healthier snack options demonstrate encouraging patterns that support more nutritious and healthy alternatives in vending machines.

Evaluation of the food environment of public hospitals in a Brazilian metropolis.

OBJECTIVE: To characterise the food environment of public hospitals in a Brazilian metropolis. DESIGN: A cross-sectional study involving the audit of mini-kitchens, non-commercial food services, commercial food services and vending machines within hospitals and interviews with workers and managers. Environmental dimensions assessed included: availability, accessibility, affordability, convenience, nutrition information, promotion and advertising, infrastructure for food and ambience, in addition to decisions-level aspects. SETTING: Rio de Janeiro, Brazil. PARTICIPANTS: 24 public hospitals in the municipal health network. RESULTS: Of the hospitals assessed, 92·0 % had a non-commercial food service, 87·5 % had mini-kitchens (facilities to consume food taken from home), 37·5 % had commercial food services and 25·0 % had vending machines. Mini-kitchens were available in most but not all hospitals, a key facility given that few commercial or non-commercial food services were open 24 h a day. The food availability in the hospitals surveyed did not promote healthy eating. A wide variety of ultra-processed foods and drinks was found and advertising promoting their consumption, even in non-commercial food services with menus planned by nutritionists. Water filters/fountains were present in around 50 % of mini-kitchens and non-commercial food services but were unavailable in commercial food services. According to workers interviewed, the temperature of the environment was the worst-rated aspect of mini-kitchens, non-commercial food services and commercial food services. Nutrition service managers reported little involvement in producing biddings and proposals for hiring outside companies to run non-commercial food services or commercial food services. CONCLUSION: The food environment of the hospitals studied did not promote healthy eating habits.

Recreation Facility Food and Beverage Environments in Ontario, Canada: An Appeal for Policy.

Canadian, municipally funded recreation/sport facilities typically have unhealthy food environments. Ontario, unlike some provinces, lacks a voluntary recreation facility nutrition policy. This study assessed the healthfulness of food environments and vending sales in 16 Ontario recreation/sport facilities and, secondarily, compared data from facilities within municipalities that banned versus permitted plastic bottled-water sales (water-ban, n = 8; water, n = 8) to test the nutritional effects of environmental policy. Concession and vending packaged food/beverage offerings and vending sales were audited twice, eighteen months apart. The products were categorized using nutrition guidelines as Sell Most (SM), Sell Sometimes (SS), and Do Not Sell (DNS). Both water and water-ban facilities offered predominantly (>87%) DNS packaged food items. However, proportions of DNS and SM concession and vending beverages differed (p < 0.01). DNS beverages averaged 74% and 88% of vending offerings in water and water-ban facilities, respectively, while SM beverages averaged 14% and 1%, respectively. Mirroring offerings, DNS beverages averaged 79% and 90% of vending sales in water versus water-ban facilities. Ontario recreation/sport facilities provided unhealthy food environments; most food/beverage offerings were energy-dense and nutrient-poor. Water bans were associated with increased facility-based exposure to DNS beverage options. A nutrition policy is recommended to make recreation facility food/beverage environments healthier and to mitigate unintended negative consequences of bottled-water bans.

Availability, Nutritional Profile and Processing Level of Food Products Sold in Vending Machines in a Spanish Public University.

BACKGROUND: Given the lack of data about the nutritional value and other determinants of the consumption of foods and drinks sold in vending machines in European universities and the relevance of this sector in Spain, it is necessary to obtain scientific data on this topic. The present study aimed to assess the availability, nutritional profile and processing level of food products from vending machines at a Spanish public university and to investigate differences in nutritional profile according to the cost and promotion. METHODS: Cross-sectional descriptive study. Data from all products available (3894) were collected and analysed using the criteria of the Spanish Agency for Consumption, Food Safety and Nutrition and the United Kingdom nutrient profiling model. The items were also classified according to the degree of industrial processing through the NOVA system. Promotion was assessed, taking into account where products were displayed in vending machines. RESULTS: The most common products were sweets (23.4% of the total options), coffee (20.3%) and salty snacks (11.7%). According to the combination of the two criteria used to assess nutritional profile, 48.6% of the products were classified as with low nutritional quality (LNQ). In addition, 73.8% of the items were categorised as "ultra-processed". Foods (ß = 0.31, 95% CI 0.24, 0.39, p < 0.001) and hot drinks (ß = 0.46, 95% CI 0.39, 0.52, p < 0.001) with high nutritional quality (HNQ) were more likely to have higher prices than alternatives with LNQ. Both foods and cold drinks that support healthy dietary recommendations were promoted to a lesser extent than those with LNQ (p < 0.001). CONCLUSION: Almost half of the products were of LNQ and three-quarters had a high level of processing. Moreover, foods and cold drinks with LNQ were less expensive and more often promoted than alternatives with HNQ.

Nutritional quality of beverages available in vending machines in health and social care institutions: do we really want such offers?

BACKGROUND: Vending machines represent one way of offering food, but they are overlooked in the efforts to improve people's eating habits. The aim of our study was to analyse the variety and nutritional values of beverages offered in vending machines in social and health care institution in Slovenia. METHODS: The available beverages were quantitatively assessed using traffic light profiling and the model for nutrient profiling used by Food Standards Australia New Zealand. Vending machines in 188 institutions were surveyed, resulting in 3046 different beverages consisting of 162 unique product labels. RESULTS: Between 51 and 54% of beverages were categorised as unhealthy with regard to sugar content. Water accounted for only 13.7% of all beverages in vending machines. About 82% of beverages in vending machines were devoted to sugar-sweetened beverages, the majority (58.9%) presented in 500-ml bottles. The average sugar content and average calories in beverages sold in vending machines are slightly lower than in beverages sold in food stores. CONCLUSIONS: We suggest that regulatory guidelines should be included in the tender conditions for vending machines in health and social care institutions, to ensure healthy food and beverage choices.