Develop Policies that Support Healthy Options in Vending Machines. Action Packet

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1 Develop Policies that Support Healthy Options in Action Packet

2 Acknowledgments Acknowledgments March 2004 Vending Policy Action Packet Work Group Lori Kaley, Chair, Muskie School of Public Service, University of Southern Maine Mary Ann Bennett, Maine Nutrition Network Judy Gatchell, Maine Nutrition Network Merry Harkins, Bath Middle School Janet Leiter, Maternal and Child Health Nutrition Program, Bureau of Health, Maine Department of Human Services Karen O Rourke, Maine Center for Public Health Kristine Perkins, Oral Health Program, Bureau of Health, Maine Department of Human Services Sarah Platt, Maine Dairy and Nutrition Council Amy P. Root, Muskie School of Public Service, University of Southern Maine Keith Whalen, Maine Cardiovascular Health Program, Bureau of Health, Maine Department of Human Services Beth Williams, Maine Nutrition Network Jennifer Willey, Canteen Service Company We would like to thank the following people for their contribution to this project: William Goddard, Muskie School of Public Service, University of Southern Maine Linda Kennedy, Muskie School of Public Service, University of Southern Maine Anne-Marie Davee, Muskie School of Public Service, University of Southern Maine John Elias Baldacci, Governor John R. Nicholas, Commissioner Printed under appropriation #: A In accordance with Federal laws, the Maine Department of Human Services does not discriminate on the basis of sex, age, color, national origin, or disability in admission or access to or treatment or employment in its programs and activities. The Department s Affirmative Action Coordinator has been designated to coordinate our efforts to comply with and implement these Federal laws and can be contacted for further information at 221 State Street, Augusta, Maine (207) or (TTY) Funding is provided by The United States Department of Agriculture, Food and Nutrition Service. Feel free to make photocopies of any pages you use. 1

3 Table of Contents 1 Take action in your community! This packet will get you started. This Action Packet focuses on developing policies that support healthy options in vending machines. It provides the tools and resources you need to create partnerships that will help you achieve your goals. This Action Packet contains: Section 2 Background Background Information Section 3 Real Maine Examples Bath Iron Works (BIW) Vending Changes Casco Bay YMCA L.L.Bean Lisbon Schools Maine School Administrative District (MSAD) #22: Hampden, Newburgh, Winterport Old Orchard Beach (OOB) Schools Vending Policy Maine School Administrative District (MSAD) #75: Mt. Ararat High School School Union #106: Robbinston, Calais, Alexander, Baring Plantation, Crawford Section 4 Action Steps Section 5 Presentation Materials Action Steps: To Guide Your Process Step 1 Stock Up Step 2 Go Browsing Step 3 Dispense Ideas Step 4 Push the Right Buttons Step 5 How s My Driving? Step 6 Count Your Change PowerPoint Presentation Script Attendance Sheet Adult Fact Sheet Child and Youth Fact Sheet

4 Table of Contents 1 Press Release Tips Generic Press Release Invitation to Presentation Flyer (in front cover) Section 6 Resources Key Contact List Web Resources References Section 7 Support Materials General Information Vendors Healthy Beverages and Snacks Available from Maine Vendors Defining Healthy Food How to Read a Food Label Sample Policy School Information Federal and State Regulations around Food Sales in Maine Schools How to Calculate if Foods and Beverages Meet the 5% Rule Joint Position of the Maine Dietetic Association and the Maine School Food Service Association School Foods Tool Kit Document Summary Section 8 Vending Machine Policy Packet 2002 The Soda/Snack Vending Machine Policy Initiative Model School Vending Machine Policy Evaluation Study of a Snack/Soda Policy in Schools Soda/Snack Initiative Partner List Contacts for Further Information Fact Sheets Body Weight and Sugar Bone Health and Soda Tooth Decay and Sugar Fact Sheet References Publicity for Local Soda/Snack Initiatives Sample Press Release How to Create and Implement Policy Liquid Candy Article

5 Background Information 2 Getting Healthy Change from Your Change Fifty-seven percent of Americans consume meals and snacks away from home on any given day. Food away from home includes foods and beverages purchased from vending machines. Foods and beverages sold in vending machines do not have to meet specific standards for certain nutrients and may be high in calories, total fat, saturated fat, added sugars, cholesterol, and sodium. School nutrition policies must be developed that limit the sale of less healthy food choices or competitive foods. Policy changes can be made for vending machine options as well as food sold for fund-raising events, a la carte choices in the school cafeteria, and snacks sold in school stores. Employers and employees can work together to ensure that vending machines at worksites include healthy snacks and beverages. Vending machines are found in large and small businesses, town offices, community and recreation centers, retail and grocery stores, sports arenas, government buildings, etc. Look for places in your community where vending machines are located and start building support for healthy changes. Why This Is Important Improving nutrition and increasing physical activity can prevent and control the epidemic of overweight and obesity, as well as decrease the risk of chronic diseases including cardiovascular disease, diabetes, cancer, and osteoporosis. Policy and environmental changes for nutrition and physical activity make it easy for everyone to choose healthier options. Developing policies that support healthy options in vending machines makes healthy choices more widely available. Policies include written laws, regulations, and rules that have the power to guide behavior. Environmental interventions include changes to the economic, social, or physical environment. Settings where foods and beverages are sold from vending machines are especially suitable for environmental interventions. For More Information See Section 5 for Fact Sheets, pages See Section 6 for Resources, pages

6 Examples 3 Bath Iron Works (BIW) Vending Changes WHAT: Building Healthy Ways is a worksite- and community-based program to improve the health of all BIW workers and their families. One of their first initiatives was to highlight healthier options in the BIW vending machines. WHY: By adopting healthy lifestyle patterns, BIW employees would be taking better care of themselves, be healthier, and ultimately be more productive at home and work. WHO: Building Healthy Ways is a health initiative designed by union representatives and BIW management. Phyllis Wolfe is the Wellness Manager. Employees at BIW are primarily blue-collar males with an average age of 47 years. Many of the employees at BIW are physically active and need healthy foods and drinks to be productive at work and home. The goal of this worksiteand community-based program is to improve the health of all BIW workers and their families. HOW: In July 2001, an interest survey was sent out to all households of BIW employees. A 33% return indicated that nutrition and eating well were top concerns. Using the results of the survey as a starting point, the vending machine contents were looked at within the first three months of the program, and ideas for highlighting low fat items were considered. There are three classifications of vending machines at BIW: beverage, snack, and refrigerated. BIW does not mandate what items will be sold in the machines. Instead, they keep a variety of items, which provides choices for employees. Stickers are placed next to the items with less than 30% of calories from fat. All of the snack machines now contain at least five low fat choices such as dried fruits, nuts and seeds, microwave light popcorn, and animal crackers. In the summer, the beverage machines contain more Gatorade, and in the winter more juice is added. By replacing the machines that sold only canned items with bottles, water and bottled 100% juices are now available at all machine locations. There are several ways the employees have access to many snack, beverage, and refrigerated vending machines in the BIW facilities, but there is no cafeteria on-site. The vending company that BIW works with is Canteen Service Company, which is located in Lewiston. BIW has an excellent relationship with this company. Revenue from the machines goes to charitable organizations in the area and the company s recreation association (BIWRA). People are free to make their own choices from the machines, which now include healthier alternatives. BIW has made significant moves to please the more health-conscious employees and also to increase the awareness of healthy alternatives for those who are more inclined to choose less-than-healthy snacks and beverages. 5

7 Examples 3 Bath Iron Works (BIW) (continued) WHEN: After initially contacting the vendor about healthier options, the Wellness Manager presented the idea to the Wellness Committee. The committee agreed that it was a good idea, and two weeks later they spoke with Canteen Vending to discuss the proposed changes. When BIW went on holiday break (December 2001), Canteen Vending made the changes in the machines. Simultaneously, flyers were sent out to the homes of employees, and internal promotional information about the changes was distributed. The entire process from planning through implementation took approximately two months. RESOURCES: With the help of the Internet, the Building Health Ways Web site, newsletter, and sponsored programs, there are many resources available to BIW employees who want healthrelated information. A newsletter is sent out quarterly and the Web site is updated monthly. Additional support materials such as posters, magnets, and stickers are used to educate employees and identify items that are low fat choices. LESSONS LEARNED: The Wellness Committee and Wellness Manager have been instrumental in promoting health and well-being, increasing employee morale, and increasing employee and family awareness of healthy lifestyle patterns and of the company s healthcare benefits. The position was created in 2001, and its campaigns and information offered to employees since then have been successful and well-received. KEY CONTACT: Phyllis Wolfe, MPH BIW Wellness Manager 700 Washington Street/MS 2110 Bath, ME Phone: (207) Fax: (207)

8 Casco Bay YMCA Examples 3 WHAT: The Casco Bay YMCA in Freeport made changes to their vending machines to model healthy lifestyles. Through this process, the staff worked with vending companies to eliminate candy, soda, and other unhealthy snacks. WHY: According to the Director, the YMCA is a place that should be safe for children and adults and should promote healthy lifestyles including good eating habits. If the vending machines provided unhealthy foods, then the Y felt it was not being a role model for healthy lifestyles. WHO: The change to the vending machines had an impact on the entire membership of the Casco Bay YMCA, which is approximately 6,500 people. HOW: The staff at the YMCA decided that they wanted to improve the offerings in the vending machines. They contacted their vending machine supplier to discuss the issue. The supplier was very helpful. They met with the supplier to select items that were healthier (i.e., no candy) and eliminated soda from the machines. Their primary concern was not the revenues the machine generated, although it was a concern for the vending supplier. The staff had a few complaints from teenagers when the soda was removed, but otherwise it was well-received. No specific information is available on loss/gain of revenue; however, the staff feel that there probably was some initial loss. No formal policy was developed. It is essentially an agreement between the supplier and the YMCA and an unwritten policy of the YMCA staff. The staff periodically reviews the offerings, and although no specific nutrition guidelines are used, the obvious junk food chips, candy, soda are not included in the vending machines. WHEN: The YMCA staff met approximately two years ago to discuss the issue. Changes to the vending machines were implemented shortly after that. LESSONS LEARNED: The change was well-received. FUTURE PLANS: Keep it going. KEY CONTACT: Scott Krouse Executive Director Casco Bay YMCA Casco Bay Branch & Pineland Branch 14 Old South Freeport Road Freeport, ME Phone: (207) ext. 27 7

9 L.L.Bean Examples 3 WHAT: Improve the quality, quantity, and affordability of healthy food choices available in vending machines throughout the company. WHY: Our 2000 and 2002 employee health surveys identified unhealthy weight levels as a risk factor for our employees. Improving the food choices available at L.L.Bean was one of several programs put in place to help employees achieve and maintain a healthy weight. We also worked to increase awareness of what a healthy choice would be and to provide nutrition education to employees. This effort was implemented as part of the Healthy Bean Initiative, a component of L.L.Bean s Workplace of Choice Initiative. WHO: Approximately 3,000 employees at all L.L.Bean locations within Maine were affected. The Healthy Bean Team (consisting of employee wellness, communications, and human resource professionals) worked with Canteen Service Company, our on-site food-service and vending provider to develop and implement the plan. HOW: The Healthy Bean Team met with our vending provider to discuss current offerings and what changes could be made to improve the nutritional quality of the vending items. In June 2001, only 10% of available vending items could be considered healthy (30% or less of fat). The Healthy Bean Team s goal was to increase healthy offerings from 10% to 30%. Weekly check-ins took place, and the initial months were the most challenging. Sales did not decrease, and a small increase actually occurred during the first year. Currently all snack vending machines have 40% healthy options available: 16 out of 40 different items. Education was provided to the food service staff, as well as the vending machine service staff, about why these healthy changes were taking place and how the company would be supporting this effort. Ongoing support and coordination has been maintained between the Healthy Bean Team and the vending provider in an effort to keep these changes in place and the effort moving forward. WHEN: In January 2001, the Healthy Bean Team was established as part of the Healthy Bean Initiative. Meetings with our vending provider happened in March and April Implementation of the changes began in June Ongoing changes continue. RESOURCES: It is hard to put a specific cost to this. The cost associated with the vending changes came primarily from the planning phase (staff time at meetings, product selection, etc.). The ongoing implementation costs are minimal. 8

10 L.L.Bean (continued) Examples 3 LESSONS LEARNED: We learned to implement changes slowly over time with constant communication to employees so they will know why changes are taking place. Improving and increasing the healthy offerings without eliminating choice worked well. We were afraid that there would be a significant cost to the company resulting from adding healthy items to vending machine choices. We actually found that the healthy items were well-received, they sold well, and the income from the vending machines did not change. FUTURE PLANS: Continue to work with vending provider to increase variety of healthy items available in vending machines. KEY CONTACTS: Susan Tufts Karen Knapton Wellness Program Director Health & Counseling Consultant L.L.Bean, Inc. L.L.Bean, Inc. Health Department Health Department Casco Street Casco Street Freeport, ME Freeport, ME Phone: (207) Phone: (207)

11 Lisbon Schools Examples 3 WHAT: To improve the quality of vending machine choices for students at Lisbon schools. WHY: The School Nurse observed how poorly the students were eating. She became a committee member on the statewide committee for The Soda/Snack Vending Machine Policy Initiative to learn what she could do about the problem. WHO: The School Nurse contacted the High School Principal and the Superintendent to enlist their help in changing the vending choices. The School Food Service Director was not initially involved. HOW: This project is ongoing. The Food Service Director became involved and expressed concern over the potential loss of revenue from vending machines that might occur if changes were made. However, the Food Service Director was willing to implement the changes if the Superintendent indicated the desire for change to be made. The High School Principal, School Nurse, Superintendent, and Food Service Director made up the school committee responsible for implementing the vending changes. The School Nurse surveyed approximately 40 students who indicated support for healthy vending options. Students were involved in taste-testing healthier vending options offered by one vendor. It was decided that milk machines would be added, and vendors were contacted for bids. Using the guidelines developed by the statewide committee, a list of healthful products was generated. Bids were due at the end of summer 2003, and vending changes are now in place. WHEN: To date, this has been a two-year process. During the first year the School Nurse attended the statewide committee meetings, kept the Superintendent updated with minutes, and networked with the school committee members. In April of the second year, the Food Service Director became involved. A meeting was held with the High School Principal, Superintendent, and School Food Service Director to plan the implementation of the vending changes. RESOURCES: The change in revenue that may come from vending changes has not yet been determined. Costs thus far have been time costs. Time was spent researching other states policies and vending experiences via the Internet. Time was spent at statewide meetings as well as local meetings. LESSONS LEARNED: Involving students was important in gathering data. The vendor provided snack items for the students to sample. Members of the statewide committee were helpful and proved to be valuable resources. The Food Service Director should have been involved in the change process much earlier. 10

12 Examples 3 Lisbon Schools (continued) FUTURE PLANS: A vending machine policy has not been drafted, but there are plans to consider amending the a la carte food policy now in place. KEY CONTACT: Joyce Severance, RN School Nurse Lisbon High School 591 Lisbon Road Lisbon Falls, ME Phone: (207)

13 Examples 3 Maine School Administrative District #22: Hampden, Newburgh, Winterport WHAT: Develop policies to replace soda and unhealthy snacks with healthy beverages and snacks in school vending machines. WHY: As part of a grant from the Healthy Maine Partnerships, MSAD #22 put together a Comprehensive School Health plan which set eight goals for addressing school nutrition. Changing the contents of the vending machines was one of the eight goals. WHO: The seven schools in MSAD #22: Earl C. McGraw Primary School, Leroy H. Smith Elementary School, Newburgh Elementary School, George B. Weatherbee Elementary School, Samuel Wagner Middle School, Reeds Brook Middle School, and Hampden Academy (2,278 students total). HOW: The School Health Coordinator (SHC) and the Director of Food Services (FSD) worked together to implement a change in vending machine contents. From the very beginning, they knew they wanted students to be actively involved in the decision-making process. They asked the high school student council to participate, and the council responded with a great deal of enthusiasm. The process began in the spring with a visit from the vendor that supplies the schools machines, who was more than willing to bring healthy snacks and drinks for the students to taste-test. The council also surveyed the student body, asking for input on what they might want included. There was no formal change in policy, just in practice, and the soda, candy, and pastries were replaced with water, juice, and healthier snack foods including Chex Mix, Nature Valley Granola Bars, and Fig Newtons. Students responded positively and, in a second survey, requested fruit and yogurt options. A refrigerated snack machine was added, including those selections. There was some concern about the drop in revenue, which did occur due to a smaller profit margin from the more expensive nutritional products. The revenue from the machines supports activities undertaken by the special education students, including activities like the Special Olympics. Those students also manage the machines, filling them and counting the money, as part of a hands-on learning project. The addition of a refrigerated vending machine with yogurt, fresh fruit, vegetable juices, etc., helped in offsetting the loss in revenue. WHEN: Planning began in the fall of A team representing MSAD #22 attended the Changing the Scene summit. Changing the Scene is a program that helps support healthy school nutrition and physical activity policies and environments. The summit was sponsored by the Maine Department of Education and the Maine Nutrition Network. The MSAD #22 action plan from the Changing the Scene summit included an objective to provide our students with healthy options in our vending machines. 12

14 Examples 3 Maine School Administrative District #22 (continued) The SHC and FSD delivered a formal presentation to the administrative team in the spring of 2002 which outlined the plan of action regarding vending machines. The administrators were receptive and supportive of the changes and gave their approval to move forward with the plan. Meetings with students took place later in the spring of It was at this point that the student council worked with the local vendor to taste-test and make the necessary selection of products ultimately placed in the vending machines. Implementation of the new practices began the first day of school in the fall of RESOURCES: The only resource was the staff time of the School Health Coordinator and Food Service Director. The action planning, presentation to the administrative team, and work with the students and vendors required time but no financial resources. LESSONS LEARNED: Working directly with students and vendors, including local bottlers of Coca-Cola and Pepsi, proved extremely helpful. Positive relationships can and do exist with local bottling companies. Getting initial approval and support from the administrative team was critical. Their strong commitment to the health and welfare of the children set the tone for this important environmental change in the schools. In hindsight, the School Health Coordinator and Food Service Director would have provided teachers/staff more advance notice of the changes with vending machines. A presentation to the teachers would have been beneficial, since those individuals would then be better able to address students questions and concerns from the onset. FUTURE PLANS: The primary change in employee vending machines will be adding more healthy choices. Currently revising the existing district Nutrition Policy. Sections of the policy that will be addressed to ensure consistency with our new environmental changes are: 1) Vending Machines, 2) Pouring Rights, 3) Food Sold during Fund-Raising Activities, 4) Food-Beverages at Group Events, and 5) Advertising. Our goals are to sustain our commitments and stand out in the state and in the country as leaders in nutrition and wellness for our staff and students. 13

15 Examples 3 Maine School Administrative District #22 (continued) KEY CONTACTS: Rick Lyons Chris Greenier Superintendent Food Service Director MSAD #22 Reeds Brook Middle School 24 Main Road North 28A Main Road North Hampden, ME Hampden, ME Phone: (207) Phone: (207)

16 Examples 3 Old Orchard Beach (OOB) Schools Vending Policy WHAT: Develop policies to replace soda and unhealthy snacks with healthy beverages and snacks in school vending machines. WHY: To improve the schools nutrition environment. Implemented as a collaborative effort of the Nutrition Team, School Health Coordinator, School Nurse, and School Food Service. WHO: Three schools in the Old Orchard Beach School Department: Jameson Elementary, Loranger Middle, Old Orchard Beach High (a total of 1,200 students grades K-12). HOW: The success of this project is due to a collaborative effort of the OOB Nutrition Team. This group included the School Health Coordinator, School Nurse, School Food Service, administration, and a parent. Soda was removed from all vending machines and replaced with water, juice, and milk. Candy and other snacks high in fat and with minimal nutritional value were removed from snack vending machines. Current choices such as pretzels, granola bars, and snack mixes meet the Centers for Disease Control (CDC) Guidelines for School Health Programs to Promote Lifelong Healthy Eating. A la carte items sold in the cafeteria include fruit, homemade pretzels, yogurt, bagels, salads, homemade pizza, and string cheese. Low fat milk has been added. Students have responded very positively. Vendors were consulted early in the process. Old Orchard Beach agreed to continue their contracts with the vendors, yet change the choices available for purchase, having only healthier alternatives and beverages. There has been no loss of income from the change in vending choices. WHEN: In May 2001, a School Health Index was used to determine the type and extent of health needs in the OOB schools. As a result of this process, nutrition was identified as a primary concern. In the fall of 2001, the School Health Coordinator convened the Nutrition Team. The work of this group focused on including nutrition education as a component of the health education curriculum and fostering a positive attitude about health and nutrition with all school staff. Vending was one of the issues specifically addressed. Initially, voluntary changes were made in vending choices; changes were in place by April of During the academic year, a Vending Machine Policy was drafted by the School Health Coordinator and presented to the Nutrition Team and Policy Committee for review. The draft was revised and a final version of the Old Orchard Beach Schools Vending Machine Policy was prepared. This policy was then presented to the School Board and accepted on June 12,

17 Examples 3 Old Orchard Beach (continued) RESOURCES: The only resource required in making an overall change in the OOB schools nutrition environment was staff time contributed by the collaborative partners. No financial resources were required, and the same vendors are being used. No contract changes were involved. LESSONS LEARNED: The establishment of a Nutrition Team was very positive. This group developed a strong and well-respected voice that was a strong impetus in changing the nutrition environment of the OOB schools. Working directly with the vendors proved to be a very positive experience. Early changes were made to include nutrition education as an important part of the curriculum, encouraging students to make lifestyle changes that supported the modification of the OOB nutritional environment and later policy development. Students and staff have developed a greater understanding of the role of good nutrition in overall health and have supported the changes made. Support of the School Board was critical in the success of the initiative. FUTURE PLANS: Voluntary changes are being made in school fund-raising activities that support healthy food choices. There is a common understanding of the need to offer fund-raising alternatives that support the modified OOB nutritional environment. Future efforts will continue to focus on this area. KEY CONTACT: Jackie Tselikis, RN School Health Coordinator Loranger Middle School 148 Saco Avenue Old Orchard Beach, ME Phone: (207)

18 Examples 3 Maine School Administrative District (MSAD) #75: Mt. Ararat High School WHAT: MSAD #75 used price differentials to promote the purchase of healthier choices in vending machines. During the first year, only beverages were targeted. An increase in water sales and decrease in soft drink sales were observed. WHY: This school community had mixed opinions on how to address obesity. Some people thought that the mission of the school was to teach students how to make choices and that it was not necessary for students to choose the low fat and/or low-sugar variety every day. Rather than limiting vending choices, the district chose to make the selection of healthy choices more economical. WHO: Since the school is open to the community after school and on weekends, the entire community, including the students, was potentially impacted. The committee responsible for the decision included the School Health Coordinator, other administrators, school food service staff, teachers, school nurses, health specialists and physical education specialists, guidance specialists, bus drivers, town councilors, school board members, and parents. HOW: The Fund for a Healthy Maine provided funds to develop the coordinating team and the direction to focus on nutrition and physical activity. The coordinating team discussed options and proposed their ideas. The Principal and School Food Service Director made the changes over the summer so that they were in place when students returned in the fall. This project impacted only the high school. The meetings were coordinated by the School Health Coordinator. WHEN: The planning took place over the school year. Changes were in place in the fall of RESOURCES: The program has proved cost-effective. There has not been a loss of revenue. LESSONS LEARNED: The planning process was critical to this project. Committee members learned the value of patience and the importance of involvement of a diversity of stakeholders. The Superintendent and several school board members were very supportive. FUTURE PLANS: To comply with the pending ruling from the Maine Department of Education on soda and junk food sales, MSAD #75 is in the process of drafting school policy that will eliminate soda and junk food, not only in school vending machines, but anywhere these products are sold on school property. In addition to developing a soda/junk food policy, MSAD #75 is in the process of forming a five-year Nutrition Plan that will address other nutrition issues. 17

19 Examples 3 Maine School Administrative District (MSAD) #75 (continued) KEY CONTACT: Mary Booth School Health Coordinator MSAD #75 50 Republic Avenue Topsham, ME Phone: (207) Fax: (207)

20 Examples 3 School Union #106: Robbinston, Calais,Alexander, Baring Plantation, Crawford WHAT: Develop policies to replace soda and unhealthy snacks with healthy beverages (100% juice and water) and healthy snacks in school vending machines. WHY: To address nutrition and eating habits supported by the school system. Implemented as part of a coordinated School Health Program overseen by the School Health Advisory Council (which includes parents and teachers) and supported by St. Croix Valley Healthy Communities, a Healthy Maine Partnership. WHO: The six schools of Union #106: Calais Elementary School, Calais Middle School, Calais High School, Robbinston Grade School, Alexander Elementary School, and Calais Alternative Education School (842 students total). HOW: The process for changing the contents of the vending machines began with the assistant project director for St. Croix Valley Healthy Communities and the School Health Coordinator attending a meeting of the student council at Calais High School. They offered healthy snacks and drinks to the students while they argued for removing soda and unhealthy snacks from school vending machines. As part of their case, they gave examples from other parts of the country where similar changes were taking place. The student council was initially opposed, concerned about a decrease in the $400 weekly revenue from the machines, which was a main source of funding for the student council. The wellness team and the School Health Advisory Council met with the student council again, armed with healthy snacks and 100% juice, to plead their case once more, agreeing to organize and conduct fund-raisers for the student council should there be a decline in revenue. The Principal offered to add a request in the next budget for the student council. He also offered them a compromise: The vending machines could be left on all day if they were filled with healthy drinks and snacks. The School Health Coordinator asked the press to attend the next student council meeting, where the council agreed to remove soda from the vending machines. The story was front-page news the next day. All six schools in Union #106 have removed soda and unhealthy snacks from their machines, and the high school student council has reported an increase in revenue from some machines and no change in revenue from other machines. The School Health Coordinator attended several policy committee meetings and school board meetings to provide support for approval of the vending machine policy. WHEN: Initial contact was made with the student council in June 2002, and the second meeting was held in early November By the next week, all soda and unhealthy snacks had been removed. The time frame from the initial discussion to replacement of the contents in the vending machines at all six schools took five months. The school board for Calais schools unanimously approved the official vending machine policy on February 26,

21 Examples 3 School Union #106 (continued) RESOURCES: The resources involved included staff time at meetings and minimal cost (less than $10.00) for healthy beverage and snack samples. LESSONS LEARNED: Supplying alternative snacks and drinks when speaking with students helped them realize the change wouldn t be nearly as bad as they would have suspected. The support and persistence of the School Health Advisory Council and wellness team were integral in having the policy adopted. Support of the Principal, especially when dealing directly with students and staff, was also important. Removing the soda from vending machines in staff lounges proved to generate more resistance than removing it from student vending machines. A letter from the Principal explaining the reasoning behind the change smoothed over the conflict. FUTURE PLANS: The policy guidelines for food products are not as strict as those for beverages since the 5% nutritional value rule can include things like Skittles fortified with vitamin C. After the dust settles on this first change, the School Health Coordinator would like to pursue healthier food alternatives. This will be done with the continued support of the wellness team members, the school nurses, the Superintendent, nurses on the school board, the Food Service Director, the School Health Advisory Council, and the Healthy Communities project. KEY CONTACT: Heather Erickson School Health Coordinator 24 Pine Tree Shore Alexander, ME Phone: (207)

22 Action Steps 4 Action Steps Step 1 Stock Up Identify potential partners and designate a leader. Step 2 Go Browsing Assess and identify current environments and/or policies related to the project. Step 3 Dispense Ideas Identify clear goals and create an evaluation plan with measurable outcomes. Step 4 Push the Right Buttons Outline key activities, locate resources (people, time, materials, and money) and create a timeline. Step 5 How s My Driving? Implement your plan. Step 6 Count Your Change Evaluate and monitor results. 21

23 Action Steps 4 Step 1 Stock Up Identify potential partners and designate a leader. These are the questions to ask: Who is leading this project? Check for existing groups/committees with an interest in the project. Who are the supporters? How can they help you? Who is opposed to this project? How can you get them interested? How can you create a win/win situation for everyone in the community? Who are the decision-makers? How can you get them to support the change? Is there anyone else you should consider? Use the Sign-Up Sheet on the next page to develop a list of contacts for the project. Remember to include vendors when you begin the process of establishing new policies around vending machine choices. 22

24 Action Steps 4 Identify interested partners to work on the project. Sign-Up Sheet NAME ORGANIZATION PHONE # Interested? Yes No ADDRESS Notes: NAME ORGANIZATION PHONE # Interested? Yes No ADDRESS Notes: NAME ORGANIZATION PHONE # Interested? Yes No ADDRESS Notes: NAME ORGANIZATION PHONE # Interested? Yes No ADDRESS Notes: 23

25 Action Steps 4 Step 2 Go Browsing Assess and identify current environments and/or policies related to the project. THIS IS THE MOST CRITICAL STEP. IT WILL DETERMINE THE COURSE OF ACTION FOR THE REST OF YOUR PROJECT. What changes need to be made in the current environment? Are policies currently in place? Are they monitored and/or enforced? Are the areas of greatest need identified? Is a survey or focus group needed? Use the Assessment Timeline Form on the next page to assign key people to each task: 1. Identify key decision-makers regarding policy and/or environmental changes. 2. Meet with the decision-makers to identify current policies and resources. 3. Scan the current environment to identify potential areas for change. 4. Conduct a focus group including people who will be affected by the changes. Check to see if contracts with vendors are currently in place. 24

26 Assessment Timeline Form Steps and Tasks 1. Identify decision-makers regarding policy and/or environmental changes. Who s Responsible Deliverables a. b. c. 2. Meet with the decision-makers to identify current policies and resources. a. b. c. 3. Scan the current environment to identify potential areas for change. a. b. c. 4. Conduct a focus group discussion including people who will be affected by the change. a. b. c. Jan 0_ Feb 0_ Mar 0_ Apr 0_ May 0_ Jun 0_ Jul 0_ Aug 0_ Sep 0_ Oct 0_ Nov 0_ Dec 0_ Jan 0_ 25

27 Action Steps 4 Step 3 Dispense Ideas Identify clear goals and create an evaluation plan with measurable outcomes. Once the area of need is clearly identified, the next step is to establish outcomes and a plan to evaluate them. An outcome is the desired result or what you eventually want to accomplish with the project. Use the following questions and the evaluation model to guide you in establishing and measuring outcomes: Is there an existing policy that needs modification or enforcement? Does a new policy need to be made? Is there a need for an environmental change or modification? How can you let everyone know why this is so important? Do you need to create and conduct a survey to find out who would support your desired outcome? How will you evaluate the final outcomes of your project? Use the Evaluation Model on the next page. For vending you may want to learn: What items sold more or less? Was there a change in revenue? What did vending users like or not like about the change? 26

28 Action Steps 4 Evaluation Model Introduction Evaluation is a process of using collected information to understand the effectiveness of an activity, project, or program. Project evaluation helps answer questions about how your activities are working. It can help you make informed decisions, clarify options, and provide information about projects and policies. Evaluation findings help you to demonstrate that your efforts are making a difference in many ways. Evaluation can help projects do the following: Promote your project to potential participants. Provide direction for people working on the project. Identify partners for collaboration. Guide budget planning. Retain and increase funding. Quick Easy-to-read Enhance your project s public image. User-friendly Although this handbook focuses on Recruit talented staff and coworkers. physical activity, it can be used for other Support long-range planning. health-related initiatives. Outcome Measurement Outcome evaluation helps determine whether your project has met the stated goals or outcomes derived from an action plan. Outcome evaluation, or more specifically, outcome measurement, provides a clear method for tracking what happens in your project. Also, check out the Centers for Disease Control and Prevention s Physical Activity Evaluation Handbook which is: This handbook explains how to write goals and SMART objectives. It also includes worksheets that can be copied and used for your initiatives. This handbook is available on the Web at Outcomes are the benefits or changes experienced by individuals or groups during or after participating in project activities. Exhibit 1 (p. 31) provides examples of program outcomes and the programs from which they developed. Measuring program outcomes can be viewed as a step-by-step approach whereby a system is developed for measuring outcomes and using the results. Most outcome measurement plans require that you: Choose the outcomes you want to measure. Specify the indicators that fit your outcomes. Prepare to collect data on your indicators. Analyze and report your findings. 27

29 Action Steps 4 Evaluation Model (continued) Choosing Outcomes to Measure Your project may feature a succession of initial outcomes, then progress to a set of intermediate outcomes, finally arriving at the ultimate, long-term outcome(s). For example, a project s desired long-term outcome may be the reduction of smoking-related illness in an elderly population. In order to reach this outcome, the population may first need to attend a class in smoking cessation to build the knowledge and skills that informs them of the hazards of smoking (initial outcome). Armed with new knowledge and skills, the population may actually be able to quit smoking (intermediate outcome). Finally, as a result of smoking cessation, the population may indeed reduce the occurrence of smoking-related illnesses (long-term outcome). Specifying Indicators that Match Outcomes An indicator is that observable, measurable characteristic or change that will tell you whether an outcome has been achieved. If you take a look at the indicators represented in the examples in Exhibit 2 (p. 32), you will notice that almost all the indicators are expressed in number of percent of participants achieving an outcome. Data Collection Methods Once an indicator, or a series of indicators, has been chosen, the next step is the design of a data collection method. Questionnaires are widely used and may provide a good fit for your indicators. Please see Helpful Hints for Building Good Questionnaires on page 33, which includes tips for writing workable survey questions. Interviews with key participants in your program provide rich sources of data. Formal interview formats or pre-designed questions that identify the topic areas associated with your set of indicators help to guide this method. Focus groups are pre-designed interviews conducted with small groups around a specific topic. They are relatively easy to arrange and can be an efficient way of gathering specific responses from a small, usually select, targeted group. It can be helpful to use a professional to conduct these groups. Archival forms of data already exist and may be useful. The Federal Bureau of Census (www.census.gov), the Behavioral Risk Factor Surveillance System (www.cdc.gov/brfss), and the Youth Risk Behavior Surveillance System (www.cdc.gov/nccdphp/dash/yrbs/index.htm) all provide a wealth of applicable data. Law enforcement, health departments, foundations, universities, media, all at state and local levels, are sources of valuable data. The University of Maine Cooperative Extension system provides both information and, in some instances, tips on the evaluation process. 28

30 Action Steps 4 Evaluation Model (continued) When to Implement Your Data Collection Method Because outcome measurement emphasizes viewing the results of your project activities, it makes sense to present questionnaires or other data collection methods at the end of your program. However, if you are trying to gauge the success of a particular activity with a particular group or population by administering a simple test, it will be helpful to test participants both before and after program activities or interventions. This method is commonly referred to as the Pre- and Post-Test method. Analyze and Report Your Findings A straightforward data analysis process is presented here in a step-by-step fashion. If more complex analysis seems appropriate, help often exists within state government or university communities. Task 1: Enter Data and Check for Errors Once questionnaire or other source data have been collected, the information can be transferred to a computer or handwritten spreadsheet. Task 2: Tabulate Data Most outcome indicators are expressed as the number or percent of a given measurement. To calculate basic data: Count the total number of participants for whom you have data. Count the number achieving the chosen outcomes (e.g., number who have demonstrated knowledge presented in your program; number who have demonstrated behavioral change, etc.). Calculate the percentage of participants achieving each outcome status. Calculate other needed statistics, such as averages or medians. Task 3: Analyze and Compare the Data by Key Characteristics Comparing program indicator data broken out by gender, ethnicity, socioeconomic status, or age may demonstrate that your project activities have been more successful for some types of participants than for others. Data for participants at different program sites or locations may add perspective and meaning to your data interpretation. 29

31 Action Steps 4 Evaluation Model (continued) Task 4: Present Data in Clear and Understandable Form. As you prepare reports for various audiences, remember that presenting data in tables and charts will make your data more understandable for many readers. Narrative discussion and description, especially the results of more open-ended interview or focus group results, can balance the presentation of numerical data or provide more context for understanding your data s significance. It may also be informative to review the goals you set for your project in narrative form so that your findings can be compared to those original initiatives. You may choose to make recommendations for a continuing project or suggest changes in project direction based upon your outcome findings. 30

32 Action Steps 4 Exhibit 1: Examples of Diverse Programs and Possible Outcomes (Adapted from Measuring Program Outcomes: A Practical Approach, United Way of America, 1996) These are illustrative examples only. Programs should identify their own outcomes, matched to and based on their own experiences and missions and input of their staff, volunteers, participants, and others. Program Comprehensive child care Outpatient treatment for adolescent substance abusers Emergency shelter beds on winter nights Homework guidance by volunteer tutors to children enrolled in after-school program Full-day therapeutic child care for homeless preschoolers Overnight camping for 8 12-year-old inner-city boys Congregate meals for senior citizens Possible Outcomes Children exhibit age-appropriate physical, mental, and verbal skills. Children are school-ready for kindergarten. abuse and about substance abuse addiction. Adolescents increase knowledge about the effects of substance Adolescents change their attitude towards substance abuse. Graduates remain free of substance abuse for six months after program completion. Homeless persons agree to come off the street and use the shelter. Those sheltered do not suffer from frostbite or die from exposure to cold. Youths attitudes towards schoolwork improves. Youths complete homework assignments. Youths perform at or above grade level. Children get respite from family stress. Parents receive respite from child care. Boys learn outdoor survival skills. Participants are not homebound. Children engage in age-appropriate play. Children exhibit fewer symptoms of stress-related regression. Boys develop enhanced sense of competence. Boys develop and maintain positive peer relationships. Participants have social interaction with peers. Participants eat nutritious and varied diet. Seniors experience decrease in social and health problems. 31

33 Action Steps 4 Exhibit 2: Example Outcomes and Outcome Indicators for Various Programs (Adapted from Measuring Program Outcomes: A Practical Approach, United Way of America, 1996) These are illustrative examples only. Programs should identify their own outcomes, matched to and based on their own experiences and missions and input of their staff, volunteers, participants, and others. Type of Program Outcome Indicator(s) Smoking cessation class Participants stop smoking. Number and percent of participants who report that they have quit smoking by the end of the course. Number and percent of participants who have not relapsed six months after program completion. Information and Callers access services to Number and percent of community agencies referral program which they are referred that report an increase in new participants or about which they are who came to their agency as a result of a call given information. to the information and referral hotline. Number and percent of community agencies that indicate these referrals are appropriate. Tutorial program for Students academic Number and percent of participants who sixth grade students performance improves. earn better grades in the grading period following completion of the program than in the grading period immediately preceding enrollment in the program. English-as-a-second- Participants become Number and percent of participants who language instruction proficient in English. demonstrate increase in ability to read, write, and speak English by the end of the course. Counseling for parents Risk factors decrease. Number and percent of participating families identified as at risk for No confirmed incidents for whom Child Protective Service records child abuse or neglect of child abuse or neglect. report no confirmed child abuse or neglect during 12 months following program completion. 32

34 Action Steps 4 Helpful Hints for Building Good Questionnaires (Adapted from Measuring Program Outcomes: A Practical Approach, United Way of America, 1996) Hints on Sound Wording 1. Ask questions the person is qualified to answer. Poor: Do students at your school feel pressure to smoke? Better: Do you feel pressure to smoke? 2. Keep each question short. Use simple sentences. 3. Use basic vocabulary. 4. Begin the questionnaire by catching respondents interest. For example, start with objective, interesting, easy questions. Let respondents know how the survey results will be used. Consider providing respondents with the survey results or other benefit. 5. Be concrete. Poor: Do you think it was a good movie? Better: Do you think the movie reflected good values? 6. Avoid words or phrases that may have double meanings. Watch out for this especially if the writer differs in background from the respondents. 7. Try not to ask leading questions. Poor: Since starting this program, have you had any dreams about cigars? Better: What objects have you seen in your dreams since starting this program? 8. Ask only one question at a time. Poor: Do you plan to get married and have children? Poor: Should this organization focus on teaching abstinence and providing mentors to curb teen pregnancies? Poor: When you discipline your child, do you state the rule clearly and explain the consequences of breaking the rule? 9. Watch out for hidden biases. Poor: Do you think racial conflict will continue to increase? Better: In your opinion, in the next two years, how do you think the relationships between races will change? a) for the better c) stay about the same b) for the worse d) I don t have an opinion 33

35 Action Steps 4 Helpful Hints for Building Good Questionnaires (continued) 10. Don t ask questions that are too complicated. Poor: Please rank the following 40 movies in the order you enjoyed them, with 1 being the movie you enjoyed the most and 40 being the one you enjoyed the least. 11. Be specific about time frames. Poor: Have you smoked a cigarette recently? Better: Have you smoked a cigarette in the last week? 12. Read questions aloud as a way to spot wording problems. 13. Translate the questionnaire into other languages if a significant proportion of the target audience is not likely to speak English. 14. Be aware of cultural issues that may affect how people respond (for example, reluctance to offend the interviewer, cultural focus on the collective instead of the individual, reluctance to answer more personal questions until after trust is established). 15. If the questionnaire is administered by interviewers, be sure the interviewer is appropriate for the respondents. Poor: Having an African-American interviewer ask white subjects about racial tension. Poor: Having a county social worker ask social workers about their feelings toward social workers. 16. Don t ask questions that are too personal if you can avoid it. Poor: What was your annual income last year? 17. Be sure there is an appropriate response option for every possible respondent. Poor: What is your race/ethnicity? White/European Asian Native American Latino/Latina African American Puerto Rican Other Poor: What is the religion of the people you date? I only date people from my faith. I date people from other faiths. 34

36 Action Steps 4 Helpful Hints for Building Good Questionnaires (continued) 18. If the response options are numeric, be sure that the ranges do not overlap. Poor: How old are you? Less than 18 years old 18 to 30 years old 30 to 50 years old Over 50 years old 19. Resist the urge to include questions just because you are curious what the answers will be. This may lengthen the survey so much that respondents will be less likely to complete it. Poor: Asking respondent income when you have no reason to think income affects the answers respondents will give. 20. If you use a series of rating questions, avoid response set (that is, the same response option consistently associated with the right answer). Poor: Case managers should assess the needs of the client. SA A N D SD Case managers should be readily available to the client. SA A N D SD Case managers should know about other services in the community. SA A N D SD Hints on Format/Style 1. Group related questions together, starting with least personal and most obviously relevant. 2. Be sure instructions are short and explicit. 3. Minimize skip patterns (for example, If you answered no to this question, please go to question 17 ). 4. Avoid having the questionnaire copied on both sides of the paper. 5. Make the questionnaire easy to read (for example, plenty of white space, a clean typeface, preferably 12-point font but at least 11-point). 6. If the survey is on colored paper, be sure that it is a shade that copies well. 7. Leave enough space on written surveys so that the answers are clearly readable. 8. If you use scales or checklists, make them all run in the same direction. I like answering survey forms. Yes No I like working in my garden. Yes No 35

37 Action Steps 4 Helpful Hints for Building Good Questionnaires (continued) 9. Make parallel statements. Poor: I like answering survey forms. Yes No I don t like chocolate. Yes No Remember to pre-test the questionnaire! 36

38 Action Steps 4 Step 4 Push the Right Buttons Outline key activities, locate resources (people, time, materials, and money) and create a timeline. At this point, it is essential to plan activities and assign tasks with a specific timeline for completion. CREATING POLICY AND ENVIRONMENTAL CHANGES CAN BE A SLOW PROCESS, SO PLAN ACCORDINGLY. Sample Activities: Develop an evaluation plan. Schedule regular meetings with partners. Document meeting activity. Identify and recruit various audiences for presentations. Schedule and give advocacy presentations. Identify potential resources including funding and manpower. Create short- and long-term timelines for the entire project. Use the Planning Worksheet provided to document names and dates assigned to key activities. 37

39 Action Steps 4 Planning Worksheet Date: Time: Location: Partners Present: Project Name: Next Meeting: Use this worksheet to help you with your planning process. Activities Who is assigned activity? Due Date 1) 2) 38

40 Action Steps 4 Activities Who is assigned activity? Due Date 3) 4) 5) 39

41 Action Steps 4 Step 5 How s My Driving? Implement your plan. Use the Planning Worksheet (on previous two pages) to continually guide the work of the group. Make partners accountable for completing key activities and reporting progress. Highlight, celebrate, and share successes along the way. Include a progress report from each partner at all regular meetings. Modify your plan as needed according to how work proceeds. Share ongoing accomplishments with decision-makers, supporters, interested partners, and those affected by changes. 40

42 Action Steps 4 Step 6 Count Your Change Evaluate and monitor results. Use the following questions to guide you in evaluating and monitoring the project: Has a change occurred in the social or economic environment? Has a change occurred in the physical environment? Has a policy been developed? Has a shift occurred in healthy behaviors because of your work? Are policies followed? What is not working? Why? Other options? Did you reach your outcome(s)? What lessons have you learned along the way? How have you informed key audiences of progress and changes? How have you promoted the project? How have you celebrated your success? Check back to your evaluation plan for outcome results. 41

43 Presentation Script Presentation Materials 5 This presentation script can be used when giving the PowerPoint slide presentation. The script may be read as is or you can edit as necessary to provide your audience with local information. Slide 1 Hello and welcome. My name is. I am from. Thank you all for coming today to this important presentation. The title of this presentation is Develop Policies that Support Healthy Options in. I invite you to participate in a discussion at the end of these slides. Please add your name and contact information to the attendance sheet I m circulating. Note to presenter: Attendance sheet is at the end of the presentation script. Slide 2 The presentation today will cover the following components: Policy and environmental change strategies Why have healthy options in vending machines? Why is this important? What can you do? and, Next steps Slide 3 Public health experts recommend policy and environmental change strategies that make it easy for everyone to eat healthy. Policies include laws, regulations, and rules (both formal and informal) that have the power to guide behavior. By developing policies that support including healthy options in vending machines, the healthy choice can also become the easy choice. 42

44 Presentation Materials 5 Presentation Script (continued) Slide 4 Environmental change strategies include changes to the economic, social, or physical environments. Community, school, and worksite settings where food and beverages are sold from vending machines create an especially suitable opportunity for environmental changes to occur. Slide 5 The Dietary Guidelines for Americans recommend that Americans eat a diet that is moderate in total fat, low in saturated fat and cholesterol, and that we choose foods with less salt and added sugar. It is also recommended that Americans choose a variety of whole grain foods, fruits, and vegetables every day. Currently in the U.S., 57% of Americans consume meals and snacks away from home on any given day. Food away from home includes foods and beverages purchased from vending machines. Foods and beverages sold in vending machines do not have to meet specific standards for certain nutrients and may be high in calories, total fat, saturated fat, added sugars, cholesterol, and sodium. Foods and beverages offered in vending machines can include healthy options that will improve the quality of our diets and our health. 43

45 Presentation Materials 5 Presentation Script (continued) Slide 6 There is a national obesity epidemic and more than half of Maine people are overweight or obese. The financial burden of overweight and obesity in the U.S. in 2000 was estimated at $117 billion, nearly 10% of U.S. healthcare expenses. Recent studies show that obesity is more strongly associated with chronic medical conditions and reduced-related quality of life than smoking, heavy drinking, or poverty. Slide 7 Improving nutrition by developing policies that support healthy options in vending machines can prevent and control this epidemic, as well as decrease the risk of chronic diseases including cardiovascular disease, diabetes, cancer, and osteoporosis. Slide 8 Our plan is to identify who is interested in developing policies that support healthy options in vending machines in this community/school/worksite. We need to assess the current environment and policies and identify a clear goal for this project. We have an Action Packet specifically designed to guide the process. 44

46 Presentation Materials 5 Presentation Script (continued) Slide 9 We plan to use this Action Packet from the very beginning to the end of this project, and the first step is to gather interested parties. That is why we are here today. We would like to hear your reaction and feedback to this idea of developing policies that support healthy options in vending machines. Our next step is to set up a meeting of interested partners to begin the action planning process. Note to presenter: At this time prompt the audience by asking the questions on slide 9, one by one. Be patient. Allow people to be silent for a while at first; often they are still thinking. Circulate a copy of the table from Step 1 called Identify interested partners to work on the project. Your goal should be to have a meeting date and time set with these newly identified partners before leaving the presentation. Slides Here are several references for the information presented here. Thank you. 45

47 Presentation Materials 5 Presentation Script (continued) Slides (continued) 46

48 Presentation Materials 5 Attendance Sheet Date of Presentation: Location: Time: Number of Attendees: Presenter s Name: Attendees: Name Phone Address 47

49 Presentation Materials 5 Attendance Sheet Attendees: Name Phone Address 48

50 Presentation Materials 5 Adult Fact Sheet Foods and beverages consumed from vending machines: Fifty-seven percent of Americans consume meals and snacks away from home on any given day. Food away from home include foods and beverages purchased from vending machines (Borrud, L.G.; et al. Eating Out in America: Impact on Food Choices and Nutrient Profiles. Speech by L.G. Borrud, Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Center, U.S. Department of Agriculture at the 124th Annual Meeting of the American Public Health Association, November 20, Available from: More than 45% of money spent on food goes to foods eaten away from the home (Clauson, A. Share of food spending for eating out reaches 47 percent. FoodReview. 1999; 22(3): 20-22). Foods eaten away from home are higher in fat, sodium, and calories and are lower in fiber and calcium. This has a major impact on the quality of foods Americans are eating and contributes to the obesity epidemic (Guthrie, J.F.; Lin, B.H.; and Frazao, E. Role of food prepared away from home in the American diet, versus : changes and consequences. Journal of Nutrition Education and Behavior. 2002; 34: ). Obesity epidemic: Fifty-nine percent of Maine adults are overweight or obese (Maine Behavioral Risk Factor Surveillance System, 2002). Overall, the direct costs of obesity and physical inactivity account for approximately 9.4% of U.S. healthcare expenditures (Mokdad, A.; et al. The continuing epidemic of obesity in the United States. Journal of the American Medical Association. 2001; 286(10): ). In 2000, the total indirect cost of obesity was estimated to be $56 billion. Indirect costs are both the value of wages lost by people unable to work due to illness or disability and the value of future earnings lost due to premature death (U.S. Department of Health and Human Services. The Surgeon General s call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; [2001]. Available from: U.S. GPO, Washington). Eating behaviors: Seventy-one percent of Maine adults do not eat the recommended five servings of fruit and vegetables each day (Maine Behavioral Risk Factor Surveillance System, 2002). Between , the amount of soft drinks consumed by both men and women surpassed their intake of milk (Wilkinson Enns, C.; Goldman, J.D.; and Cook, A. Trends in Food and Nutrient Intakes by Adults: NFCS , CSFII , and CSFII Family Economics and Nutrition Review. 1997; 10(4): 2-15). 49

51 Presentation Materials 5 Child and Youth Fact Sheet Foods and beverages consumed from vending machines: Nationally, 95% of high schools, 62% of middle schools, and 26% of elementary schools had vending machines selling foods and beverages in 2000 (Wechsler, H.; et al. Food Service and Foods and Beverages Available at School: Results from the School Health Policies and Programs Study, Journal of School Health. 2001: 71(7): ). School nutrition policies must be developed that limit the sale of less healthy food choices or competitive foods (Position of the American Dietetic Association, Society for Nutrition Education and American School Food Service Association Nutrition services: An essential component of comprehensive school health programs. Journal of the American Dietetic Association. 2003; 103(4): ). Foods and beverages sold in vending machines do not have to meet specific standards for certain nutrients and may be high in calories, total fat, saturated fat, added sugars, cholesterol, and sodium (Kramer-Atwood, J.L.; et al. Fostering healthy food consumption in schools: Focusing on the challenges of competitive foods. Journal of the American Dietetic Association. 2002; 102(9): ). All foods/beverages sold in Maine schools must meet or exceed the 5% minimal nutritional value rule (Federal Guidelines: 7 CFR Part Competitive Food Services. August State Guidelines: Authority: 20MSRA Section 6602(5). Effective Date: August 31, 1979, Amended February 21, /97 Maine Department of Education). Obesity epidemic: Thirteen percent of Maine high school students are overweight and 15% are at risk for becoming overweight (Maine Youth Risk Behavior Survey, 2003). Thirteen percent of Maine middle school students are overweight and 18% are at risk for becoming overweight (Maine Youth Risk Behavior Survey, 2003). Fifteen percent of Maine kindergarten students are overweight and 21% are at risk for becoming overweight (Maine Child Health Survey, 2002). During the past two decades, the percentage of children who are overweight has nearly doubled and the percentage of adolescents who are overweight has almost tripled in the U.S. (National Center for Health Statistics, Centers for Disease Control and Prevention. Prevalence of overweight among children and adolescents: United States, 1999 [Internet]. [Hyattsville (MD)]: NCHS [cited 2001 Oct 31]. Available from: /over99fig1.htm]. over99fig1.html). Overweight children have an increased risk of high blood pressure, high cholesterol levels, Type 2 diabetes, early heart disease, and becoming obese adults (Dietz, WH. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics 1998 Mar; 101(3) Suppl: ). 50

52 Presentation Materials 5 Child and Youth Fact Sheet (continued) In the United States over the past twenty years, obesity-associated annual hospital costs for youth aged 6 to 17 years have increased more than threefold, from $35 million in to $127 million in (Wang, G.; Dietz, W. Economic burden of obesity in youths aged 6 to 17 years: Pediatrics 2002 May; 109(5): e81. Available from: Eating behaviors: Children with the highest consumption of total sweetened beverages consume more calories (about 330 extra per day) than those who do not drink sweetened beverages. Those children who drink the highest amounts of sweetened beverages also consume more high-fat vegetables, such as french fries, and 57-62% less fruits (Cullen, K.; et al. Intake of soft drinks, fruit-flavored beverages, and fruits and vegetables by children in grades 4 through 6. American Journal of Public Health. 2002; 92(9): ). Seventy-seven percent of Maine high school students do not eat the recommended five servings of fruit and vegetables each day (Maine Youth Risk Behavior Survey, 2003). Children who drink soft drinks consume more total calories than those who do not consume soft drinks. Those children in the highest soft drink consumption category consumed less milk and fruit juice compared with those in the lowest category (nonconsumers) (Harnack, L.; Strang, J.; and Story, M. Soft drink consumption among U.S. children and adolescents: Nutritional consequences. Journal of the American Dietetic Association. 1999; 99(4): ). Seventy-eight percent of Maine high school students do not consume the recommended servings of milk each day (Maine Youth Risk Behavior Survey, 2003). Schools play a critical role in producing healthy students who are better able to develop and learn by establishing an environment that supports a nutritious diet (U.S. Department of Health and Human Services. Healthy People Second ed. Washington, D.C.: U.S. Government Printing Office. November 2000). Each 12 oz. can of a carbonated non-diet soft drink contains approximately 10 teaspoons of sugar (Larson Duyff, R. American Dietetic Association Complete Food and Nutrition Guide, Second Edition. Hoboken, NJ: John Wiley & Sons, Inc., page 169, 2002). 51

53 Presentation Materials 5 Press Release Tips Below are some commonsense tips for using a press release: Know who your audience is, why you are writing the release, and what you want them to learn by the time they have finished reading. Know which media your audience reads; keep accurate lists. Know what the media deadlines are and follow them. When possible, include a black-and-white photo with your release (for print media). Including a photo often improves the likelihood that your release will be used. Sunday afternoon or evening is a great time to get your story to either a wire service or newspaper. Use the Generic Press Release on the next page to announce your community s effort for policies developed that support healthy options in vending machines. 52

54 Presentation Materials 5 Generic Press Release FOR IMMEDIATE RELEASE: (Date) PRESS CONTACT: (Name, phone number) (Community) puts healthy choices in their vending machines. (City, Maine, date) (community) is taking measures to improve nutrition and promote better health. (community leader) has announced a community-wide effort to develop policies that support healthy options in vending machines. This is seen as an important step in addressing today s obesity epidemic and reducing the incidence of heart disease, stroke, diabetes, and other related diseases. More and more people are consuming snack foods on the go, says (source). Many snack choices are from vending machines, and these foods tend to be higher in fat, sodium, and calories and lower in fiber and calcium; they are taking a toll on our health. It s important to make healthy food options more widely available. Schools and worksites are ideal venues for change. This project brought many concerned citizens and community leaders to the table. Together, they organized community presentations and met with local decision-makers to identify current policies and see how changes could be made. As a result of this effort, several (schools/worksites) have agreed to add healthy food to their vending machines. These (schools/worksites) include: (list). In time, 100% fruit juice, low fat and fat-free milk, and water will take the place of sugar-flavored drinks and soda, says (source). Our goal is to make it easy for everyone to choose healthier options. This is a project of (local project). To receive more information or to get involved in the project, call (local project phone #). ### 53

55 Key Contact List Resources 6 Jennifer Willey, Nutrition Consultant Canteen Service Company 252 Old Lisbon Road, Lewiston, ME Web site: Works with each customer to establish the right merchandising plan. Provides information about Canteen s Balanced Choice program to merchandise items lower in fat and calories. Provides a merchandising plan that complies with the USRDA standard for beverage and snack vending. Karen O Rourke, Vice President, Operations Maine Center for Public Health 12 Church Street, Augusta, ME Fax: (207) Web site: Provides additional background/research to support the policy. Assists in developing a strategy and connecting people to those who can help. Chris Greenier, Food Service Director Reeds Brook Middle School 28A Main Road North, Hampden, ME Provides expertise in the development of food sales policy. Provides information on how to get students involved in the process of making changes to vending machines. Shares experience with schools that do not enforce policies. Stacey Caruso, School Health Coordinator Waterville School Department 21 Gilman Street, Waterville, ME Fax: (207) Provides assistance with the process of test marketing new school lunch menu items. Provides assistance when working with different food vendors. Shares expertise in building healthy working relationships between food service staff and school administration. 54

56 Web Resources Resources 6 Information Resources Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity Provides science-based resources for children and adults that address the role of nutrition and physical activity in health promotion and the prevention and control of chronic diseases. United States Department of Agriculture (USDA) Food, Nutrition, and Consumer Services The gateway to two United States Department of Agriculture (USDA) nutrition sites: The Food and Nutrition Service (FNS) and the Center for Nutrition Policy and Promotion (CNPP). The FNS is a collection of initiatives directed at reducing hunger and improving nutrition. The CNPP links scientific research with the nutritional needs of the American public. Five-A-Day for Better Health Program from National Cancer Institute Promotes five fruit and vegetable servings every day with resources, recipes, promotional materials, food and nutrition policy, as well as a list of healthy vendors and their contact information. Center for Science in the Public Interest An education and advocacy organization that focuses on improving the safety and nutritional quality of our food supply; contains advice on where to get started, details real examples of nutrition policy efforts, and gives nutritional information. The School Foods Tool Kit is available at This document includes model policies, fact sheets, and sample letters that can be reproduced and used when collaborating with school decision-makers. Community Action Resources Community Toolbox An essential resource created as an on-line community health/development-organizing manual. Includes topics related to community capacity building and resource development. California Project LEAN An organization dedicated to creating healthier communities through policy and environmental efforts that support healthier eating and increased physical activity. Site contains consumer materials, healthy tips, and guides to taking community action. 55

57 Resources 6 Web Resources (continued) Action for Healthy Kids A nationwide organization working to promote the health of school children by joining forces with education and health leaders to take action for children s nutrition and physical activity. Learn how you can take action, find out what s happening in your state, or use their tools for action. The Center for Health and Healthcare in Schools This page of the Center s Web site is devoted to background information on vending, sample best practice school policies, and a list of questions for parents and community members to use in assessing nutrition programs and policies at school. Maine State Resources Maine Dairy and Nutrition Council Focused on creating a healthier school environment, the Maine Dairy and Nutrition Council is an organization dedicated to promoting good nutrition and health education. Action for Healthy Kids Maine State Profile Contains information about demographics, health, fitness, current legislation, and policies in Maine. Maine Cardiovascular Health Program Working through a network of community, government, and health partners, the Maine Cardiovascular Health Program explores prevention opportunities in neighborhood, school, worksite, and healthcare settings. The site also contains downloadable County Fact Sheets that provide county-specific information regarding tobacco use, lack of physical activity, and overweight/obesity. Maine Nutrition Network The Maine Nutrition Network (MNN) helps coordinate nutrition education activities that support the health of people living in Maine. Site includes links to the multiple projects that the Network is involved with, including Five-A-Day projects, school and children s programs, and healthy aging and community support initiatives. 56

58 References Resources 6 Borrud, L.G.; S.J. Mickle; A.B. Nowverl; K.S. Tippett. Eating Out in America: Impact on Food Choices and Nutrient Profiles. Speech by L.G. Borrud, Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Center, U.S. Department of Agriculture at the 124th Annual Meeting of the American Public Health Association, November 20, Available from: Position of the American Dietetic Association, Society for Nutrition Education, and American School Food Service Association Nutrition services: An essential component of comprehensive school health programs. Journal of The American Dietetic Association. 2003; 103(4): Wechsler, H.; N.D. Brener; S. Kuester; C. Miller. Food Service and Foods and Beverages Available at School: Results from the School Health Policies and Programs Study Journal of School Health. 2001; 71(7):

59 Vendors Support Materials 7 These vendors participated in a vending survey to identify healthy snacks and beverages. All Seasons Services 245 Rodman Road Auburn, ME Contact: Thomas Lerette Phone: (800) (207) x104 Fax: (207) Web: Region: Southern Maine and parts of Mid-Maine Athearn Vending Company 489 Appleton Road Union, ME Contact: Aaron Athearn Phone: (800) (207) Region: Bangor/Palmyra to Portland and Farmington to Blue Hill Automatic Vending & Games 167 Target Industrial Circle Bangor, ME Contact: Carolyn Smith Phone: (207) Fax: (207) Canteen Service Company 89 Industrial Park Road Saco, ME Perry Road Bangor, ME Old Lisbon Road Lewiston, ME Contact: Jennifer Willey Phone: (800) Fax: (207) Web: Region: Every county in Maine with the exception of Aroostook Coca-Cola Bangor 91 Dowd Road Bangor, ME Contact: Ron Tibbetts Phone: (207) Fax: (207) Region: Eastport to Greenville and Thomaston to Millinocket Coca-Cola Presque Isle 1005 Airport Road Presque Isle, ME Contact: Alton Hartt Phone: (207) Fax: (207) Region: Aroostook County, Danforth and Patten Coca-Cola Southern Maine 316 Western Avenue South Portland, ME Contact: Tony Phillips Phone: (800) Fax: (207) Region: From Kittery to Waterville 58

60 Support Materials 7 Vendors (continued) Fred s Vending Service RR 1, Box 1340 Oakland, ME Contact: Paul Rodrigue Phone: (207) Fax: (207) Region: Portland to Bangor and Farmington to Belfast Hedrich Vending 15 Industrial Street Presque Isle, ME Contact: Todd Hedrich Phone: (207) Fax: (207) Region: All of Aroostook County and parts of Washington County J & M Vending 67 Jarvis Gore Drive Eddington, ME Contact: Mark/Jeanine Proulx Phone: (207) Region: Bangor area, Hampden, Lincoln, Ellsworth L & L Vending 28 Ryder Bluff Road Holden, ME Contact: Scott Proulx Phone: (877) Region: Bangor area, Old Town, Route 1A to Bar Harbor, and outskirts Michaud Distributors 5 Lincoln Avenue Scarborough, ME Contact: Greg Haskell Phone: (207) Fax: (207) Region: Southern Maine New England Vending 1 Lisbon Road Lisbon, ME Phone: (207) Fax: (207) Region: Bangor to York Pine State Vending 8 Ellis Avenue Augusta, ME Contact: Larry Auger Phone: (207) Fax: (207) Region: Bethel to York, Rockland, Camden, Bangor, Waterville, Lewiston, Portland Seltzer & Rydholm 191 Merrow Road P.O. Box 1090 Auburn, ME Contact: Marcus Day Phone: (207) Fax: (207) Region: The following counties: Sagadahoc, Somerset, York, Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, half of Waldo 59

61 Support Materials 7 Healthy Beverages and Snacks* Available from Maine Vendors (at time of publication) All items may not be available from all vendors. 100% Fruit Juice Welch s Apple Grape Grapefruit Orange Dole Apple Grape Orange Minute Maid Apple Orange Orange with Calcium Tropicana Grape Ruby Red Very Fine Grape Grapefruit Orange Oakhurst Orange Juice 100% Vegetable Juice (5.5 oz., 10 oz., 11.5 oz., and 16 oz.) (5.5 oz., 10 oz., and 11.5 oz.) (5.5 oz., 10 oz., and 11.5 oz.) (5.5 oz., 10 oz., 11.5 oz., and 16 oz.) (11.5 oz. and 16 oz.) (11.5 oz. and 16 oz.) (11.5 oz. and 16 oz.) (11.5 oz. and 16 oz.) (11.5 oz. and 16 oz.) (11.5 oz. and 16 oz.) (16 oz.) (16 oz.) (10 oz. and 12 oz.) (10 oz. and 12 oz.) (12 oz. and 16 oz.) (16 oz.) Campbell s Tomato (5.5 oz. and 11.5 oz.) V-8 (5.5 oz. and 11.5 oz.) Low Fat (1%) or Skim Milk Oakhurst Low Fat (1%) or Skim Milk (16 oz.) Garelick Low Fat (1%) or Skim Milk (8 oz., 10 oz., and 16 oz.) Hood Low Fat (1%) or Skim Milk (8 oz. and 16 oz.) Fresh Fruit Granny Smith Apples Grapes Grapefruit Navel Oranges Red Delicious Apples Tangerines Low Fat Crackers and Cookies Zoo Animal Crackers Nabisco Fat-Free Fig Newtons Kellogg s/keebler Animal Crackers Pretzels (< 450 mg sodium) Rold Gold Classic Style Natural Pretzels Classic Thins Classic Tiny Twists Sourdough Specials Fat-Free Tiny Twist Snyder s of Hanover Pretzels Butter Snaps Pretzels Mini Pretzels Old Tyme Pretzel Sticks Pretzel Snaps Pretzel Specials Pretzels Sourdough Hard Pretzels Thin Pretzels Honey Mustard and Onion Nibblers Pretzels Sourdough Fat-Free Nibblers Pretzels Organic Classic Pretzels Organic Honey Wheat Sticks 60

62 Support Materials 7 Healthy Beverages and Snacks* Available from Maine Vendors (continued) All items may not be available from all vendors. Ready-to-Eat, Low-Sugar Cereals (< 6 g sugar/100 g) General Mills Cheerios in a Bowl Granola Bars (made with unsaturated fat) Kellogg s Nutri-Grain Bars Apple Blueberry Raspberry Strawberry Mixed Berry Cherry General Mills Chocolate Chip Chewy Cinnamon Crunchy Oatmeal Crisp Fruit n Cereal Bars-Apple Oatmeal Crisp Fruit n Cereal Bars-Strawberry Oatmeal Raisin Chewy Oats and Honey Crunchy Peanut Butter Crunchy Barbara s Puffins Cereal and Milk Bars Blueberry Yogurt French Toast Strawberry Yogurt Barbara s Multigrain Cereal Bars Apple Cinnamon Blueberry Cherry Raspberry Strawberry Triple Berry Low Fat or Nonfat Yogurt Colombo Classic Fruit on the Bottom Light Yogurt Yoplait Original 6 oz. Original 4 oz. Light TRIX Raisins and Other Dried Fruit (no sugar added) Mr. Nature Mr. Nature Raisins Selected Fruit Mix Kars All Energy Trail Mix Original Trail Mix Snack Mixes of Cereal and Dried Fruit (low-sugar cereal/small amounts of nuts/seeds) Canned Fruit (packed in 100% juice/no sugar added) Fresh Vegetables Bread Products (bread sticks, rolls, bagels, and pita bread) Peanut Butter and Low Fat Crackers * The beverages and snacks in this list fall under the headings (bolded) from CDC s Sample List of Vending Machine Foods Low in Saturated Fat 1 and are low in fat (< 3 grams total fat per serving and < 1 gram of saturated fat per serving). 1. Guidelines for School Health Programs to Promote Lifelong Healthy Eating. Morbidity and Mortality Weekly Report, Recommendations and Reports. Centers for Disease Control and Prevention. June 14, 1996/45(RR-9);1-33. Available at 61

63 Support Materials 7 Defining Healthy Food U.S. Food and Drug Administration (FDA) Nutrition Labeling and Education Act of 1990 (NLEA) Healthy food is defined as follows: Must be low in fat (three grams or less per serving) and low in saturated fat (one gram or less per serving) and contain limited amounts of cholesterol (60 mg or less per serving for a single-item food) and sodium (cannot exceed 360 mg per serving for a single-item food and 480 mg per serving for meal-type products). Single-item foods that are not raw fruits or vegetables must provide at least 10% of the daily value of one or more of the following nutrients: vitamin A, vitamin C, iron, calcium, protein, and fiber. Exempt from this 10% rule (and considered healthy) are certain raw, canned, and frozen fruits and vegetables; and certain cereal-grain products. American Heart Association Food Certification Program Based on the standard serving sizes established by the U.S. government, a product may: Include up to three grams total fat, up to one gram saturated fat, and up to 20 mg cholesterol. Must not exceed a sodium disqualifying level of 480 mg. Must include at least 10% of the Daily Value for at least one of six nutrients: protein, dietary fiber, vitamin A, vitamin C, calcium, or iron. Seafood, game meats, and meat and poultry products must contain less than five grams total fat, less than two grams saturated fat, and less than 95 mg cholesterol per standard serving and per 100 grams. 62

64 Support Materials 7 Defining Healthy Food (continued) U.S. Department of Agriculture Food and Nutrition Services National School Lunch and Breakfast Programs Nutrition standards for these school meal programs have been established for calories, total fat, saturated fat, protein, calcium, vitamins A and C, and iron. Foods of minimal nutritional value. Regulations that identify food and beverages that may not be sold in competition with breakfast and school lunch periods in food service areas. 63

65 Support Materials 7 How to Read a Food Label The Nutrition Facts label tells you how a food or beverage fits into your diet. It lists the nutrients in a food and makes it easier to compare products. This tells you the total calories for the serving size listed. Recommended daily total fat is less than 65 g or 30% of calories. Recommended daily total of sodium is less than 2,400 mg. 300 g or 60% of calories should come from carbohydrates every day. This is where vitamins and minerals will be listed. If you want to consume more of a nutrient, such as calcium and other vitamins and minerals, choose foods with a higher % Daily Value. Remember that in one day, your total saturated fat should be less than 20 g or 10% of calories. Your total for cholesterol should be less than 300 mg. Nutrition Facts Pretzels Serving Size 1 oz. (28 g) Amount Per Serving Calories 108 Calories from Fat 9 % Daily Value* Total Fat 1 g 2% Sodium 486 mg 20% Total Carbohydrate 23 g 8% Dietary Fiber 1 g 4% Protein 3 g 6% { Iron 7% Thiamin 9% Riboflavin 10% Niacin 7% Not a significant source of saturated fat, cholesterol, vitamin A, vitamin C, and calcium. Values are not available for sugars. *Percent Daily Values are based on a 2,000 calorie diet. This tells the serving size or amount that the nutrient information is based on. Some snacks, food, and beverages have two or more servings in the package or bottle. This shows how many of the total calories come from fat. This helps you see how a food fits into your overall daily diet. This shows that this snack provides 20% of the recommended Daily Value of sodium. 50 g or 10% of calories should come from protein every day. This means that there are not enough of these in this snack to measure. This tells you that % Daily Values are based on a 2,000 calorie diet. Ingredients If there are ingredients listed on a food label, they are listed in order by weight. If you want to use whole wheat bread, check to see that the first ingredient is whole wheat flour. When sugar is listed on the Nutrition Facts label, always check the ingredient list for the source of the sugar. What does the % Daily Value really mean? You will get 20% of your Daily Value of sodium from this snack. 100% total Daily Value You still have 80% of your Daily Value left for the rest of the day. Example: If you want to limit a nutrient, like fat, saturated fat, cholesterol, or sodium, choose foods with a lower % Daily Value. 64

66 Support Materials 7 Sample Policy I. Purpose of the Policy To improve the health of (community members/employees/employers/students/staff) by providing healthy food, snack, and beverage choices in vending machines wherever vending machines are located. II. Rationale Improving nutrition can prevent and control the epidemic of overweight and obesity, as well as decrease the risk of chronic diseases including cardiovascular disease, diabetes, cancer, and osteoporosis. Policies that support healthy food and beverage choices in vending machines make it easy for everyone to choose those options. III. Nutritious Food and Beverage Choices Nutritious and appealing foods and snacks including fruits; vegetables; low fat, low-sugar/ no-sugar-added, reduced sodium, whole grain, and low fat grain products (pretzels, granola bars); low fat dairy foods; lean meats and meat alternates; fish and poultry; and low fat or fat-free will be available in all vending machines where foods/snacks are sold or offered. Nutritious and appealing beverages, such as water, 100% fruit juices, and low fat or fat-free milks will be available in all vending machines where beverages are sold or offered. Efforts will be made to encourage and promote choosing nutritious foods, snacks, and beverages from vending machines. Food, snacks, and beverages sold in vending machines shall meet nutritional standards and other guidelines set by the (government/state organization/school health council/wellness team/nutrition committee). This includes food, snacks, and beverages sold in vending machines located in or on the property of: Employee/staff lounges, break rooms, and cafeterias Locker rooms and changing rooms Facility hallways, entranceways School cafeterias Teacher s lounges Community buildings and facilities Government offices and buildings Highway rest areas Recreation centers Retail and grocery stores 65

67 Support Materials 7 Federal and State Regulations Around Food Sales in Maine Schools I. Federal Regulations: 7CFR 210 March Competitive Food Services (a)(1) Competitive foods means any foods sold in competition with the Program (National School Lunch Program) to children in food service areas during the lunch periods. (a)(2) Foods of minimal nutritional value means: (a) In the case of artificially sweetened foods, a food which provides less than 5% of the Reference Daily Intake (RDI)* for each of eight specified nutrients per serving; (b) in the case of all other foods, a food which provides less than 5% of the RDI* for each of eight specified nutrients per 100 calories and less than 5% of the RDI* for each of eight specified nutrients per serving. The eight nutrients to be assessed for this purpose are: protein, vitamin A, vitamin C, niacin, riboflavin, thiamin, calcium, and iron. (b) State Agencies and School Food Authorities shall establish such rules or regulations as are necessary to control the sale of foods in competition with lunches served under the program. *Revised May 6, II. State Regulations: From Department of Education. Chapter 051 School Nutrition Programs in Public Schools and Institutions 2. Restrictions on Sale of Foods in Competition with School Food Programs. Any food or beverage sold during the normal school day on school property of a school participating in the National School Lunch or School Breakfast Programs shall be a planned part of the total food service program of the school and shall include only those items which contribute both to the nutritional needs of children and the development of desirable food habits. Funds from all food and beverage sales during the normal school day on school property shall accrue to the benefit of the school s nonprofit school food service program; except that the local school board may establish, by policy, a process whereby a school or approved student organization is allowed to benefit from the sale of such foods and beverages. Basis: Federal regulations required the State to establish regulations to control the sales of food in competition with the school s nonprofit food service program. To meet this requirement, the State Board of Education s 1967 policy relating to food sales was adopted. 66

68 Support Materials 7 Federal and State Regulations Around Food Sales in Maine Schools (continued) Authority: 20MRSA Section 6602(5) Effective Date: August 31, 1979, Amended February 21, 1989 I. If your School Board has adopted a food/beverage policy: a. All food/beverages sold must meet or exceed the 5% minimum nutritional value. Fiscal reclaims will occur if: a. Any food/beverages are sold by any organization or by the School Food Service Program that do not meet or exceed the 5% minimum nutritional value; both Federal and State funds will be reclaimed; or b. A policy is not followed (i.e., policy states there will be no food/beverages sold other than by the School Food Service Program and an organization sells 100% fruit juice); State funds will be reclaimed. II. If your school has not adopted a policy: a. Your school automatically follows the State of Maine s competitive foods policy: 1) Only the School Food Service Program can sell food/beverages during the school day; 2) Profits accrue to the School Food Service Program; and 3) Food/beverages must exceed the 5% minimum nutritional value rule. Fiscal reclaims will occur if: a. Any food/beverages are sold by any other organization on school property during the school day; State funds will be reclaimed; b. Any food/beverages are sold by any other organization during meal service, in the cafeteria; both Federal and State funds will be reclaimed; or c. Any food/beverages sold by the School Lunch Program on a la carte product, that does not meet or exceed the 5% minimum nutritional value; both Federal and State funds will be reclaimed. Use How to Calculate if Foods and Beverages Meet the 5% Rule on page 68. Remember that a food or beverage needs to meet the 5% minimum nutritional value for only one of the following eight nutrients: protein, vitamin A, vitamin C, niacin, thiamin, riboflavin, calcium, and iron. 10/97 Maine Department of Eduction 67

69 Support Materials 7 How to Calculate if Foods and Beverages Meet the 5% Rule Federal regulations require that foods sold in schools shall have at least one of these eight nutrients: protein, vitamin A, vitamin C, niacin, thiamin, riboflavin, calcium, and iron, in excess of 5% of the Reference Daily Intake (RDI) per 100 calories. Working with decimals We have to work with decimals in order to put this regulation into practice. If you have 200 anything, divided by 100 anything, you get You should note that the decimal point has moved to the left two places. Two would be a factor representing the relationship of 200 to 100. Moving the decimal point left two places is equivalent to dividing by 100. Using product label information Example A: If a serving of a product has 200 calories, what is the minimum percent of one nutrient needed? Process: Figure 200 calories divided by 100 = % per 100 calories X2 X2 10% per 200 calories Answer: 10% would be the minimum amount of one nutrient needed in a 200-calorie serving. Example B: If the product contains 160 calories, what is the minimum percent of one nutrient needed? Process: Figure 160 calories divided by 100 = 1.6 5% per 100 calories X1.6 X1.6 8% per 160 calories Answer: 8% would be the minimum amount of one nutrient needed in a 160-calorie serving. 68

70 Support Materials 7 How to Calculate if Foods and Beverages Meet the 5% Rule (continued) Example C: If the product contains 215 calories, what is the minimum percent of one nutrient needed? Process: Figure 215 calories divided by 100 = % per 100 calories X2.15 X % 215 calories Answer: 11% is the minimum amount of one nutrient for a 215-calorie serving because nutrients are listed only in whole numbers. DAILY VALUE Nutrient DV 5% DV Protein* 50 g 2.5 g REFERENCE DAILY INTAKE (RDI) Nutrient RDI VALUE 5% RDI VALUE Vitamin A* 5,000 IU 250 IU Vitamin C* 60 mg 3 mg Niacin 20 mg 1 mg Thiamin (B1) 1.5 mg.075 mg Riboflavin (B2) 1.7 mg.085 mg Calcium 1,000 mg 50 mg Iron* 18 mg.9 mg *These nutrients must be on a label. 69

71 Support Materials 7 How to Calculate if Foods and Beverages Meet the 5% Rule (continued) Comparing calories or percentages of a product to 100 calories Comparison Equation: 100 calories = X Calories of product Nutrient mg (or % RDI) i.e., apple juice contains 138 calories and 5.9 mg vitamin C (or 8% RDI) Compare Nutrient in mg or Compare by Percentage 100 calories = X 100 calories = X 138 calories 5.9 mg 138 calories 8% 100 x 5.9 = 138 x X 100 x 8 = 138 x X 590 = X 800 = = X mg 5.8% mg is more than 3 mg and 5.8 is greater than 5% (5% or RDI) for 100 calories. for 100 calories. Adapted from Maine Department of Education, Child Nutrition Services Does Your A La Carte Product Make the Grade? 70

72 Support Materials 7 Joint Position of the Maine Dietetic Association and the Maine School Food Service Association Nutrition Services in Maine Schools It is the position of the Maine Dietetic Association and the Maine School Food Service Association that Maine schools provide an environment to support nutrition education, encourage the consumption of healthy foods, and promote regular physical activity. In this context, the foods served within the School Lunch Program and competitive foods should exemplify what constitutes healthy foods. The Associations also believe that a comprehensive approach towards the improved health of our children needs to come from a partnership of the schools, parents, and community. RATIONALE: There is numerous evidence to support the worsening health and rising obesity in American children. Many children consume at least one-third of their daily food intake in the school setting. Having healthy foods available could contribute to better nutrient intake and a more appropriate level of calorie consumption. Good nutrition provides the foundation for student growth, development, and learning. Healthy eating can improve academic performance, attendance, mood, alertness, and behavioral issues. By the schools modeling healthy food choices, children will be receiving a message consistent with nutrition information taught in the classroom. Behavioral changes are more permanent if there is the opportunity to put the information received into action. By children practicing healthy eating behaviors at school, they are more likely to extend these behaviors into the home and into later life. Evidence also points to the need for children to be more physically active. Schools should provide adequate time for children to participate daily in moderately vigorous physical activity as recommended by Federal guidelines (U.S. Surgeon General s Report; U.S. Dietary Guidelines). RECOMMENDATIONS: Improve Nutrition Education Nutrition education should be provided for not only children, but for school administrators, teachers, staff, food service personnel, and parents. A qualified nutrition professional should be available as a consultant for each school district for such purposes and to assist the schools in developing and implementing school nutrition policies. It is recommended that at least one food service employee in each district be certified as a nutrition specialist by the American School Food Service Association. 71

73 Support Materials 7 Joint Position (continued) Put the Value of Nutrition into Action To reinforce nutrition education in the classroom, foods served in the school environment should model healthy eating. At minimum, this includes foods served in the School Lunch Program, a la carte items, foods served in school stores, and all vending machines on school property. It is suggested that each district develop a comprehensive policy regarding all foods offered on school grounds. This might include but not be limited to fund-raisers, reward systems in classrooms, concessions, school functions, corporate-sponsored teaching materials/promotionals/product giveaways. Healthy foods would be defined as fruits, vegetables, whole grains, low fat animal protein foods, low fat dairy products, legumes/soy products, nuts, and seeds. Foods served would be relatively low in fat (especially saturated fat), sugar, and sodium (see Appendix for specific recommendations). This would exclude sodas, sports beverages, candy, a number of high fat/high sugar/ nutrient-poor snack foods, and fortified foods that do not fit into one of the above food group categories. Adding vitamins and/or minerals to a basically unhealthy food does not change it into a healthy food. (Maine s current interpretation of foods of minimal nutritional value, or the 5% rule, allows less healthy foods that are fortified to be served.) Schools should not allow marketing of less healthy food items and should instead promote the consumption of healthy food choices. Children bringing snacks or meals to school should be strongly encouraged to make healthy food choices. Open campuses where students are allowed to leave school grounds, especially during lunch, appear to counter healthy food policies by creating competition from fast-food restaurants and convenience stores. Students should be required to remain on school grounds at least during meal service. Adequate time should be allowed for children to consume meals. The recommendation is to provide at least 20 minutes of actual eating time per meal (not counting time spent waiting in line for food). Schools should also limit interference from other student meetings occurring during the lunch period. Recess is often after lunch, which means that children rush through their meals, consume inadequate amounts of food, or choose less healthy foods that are faster to eat. Changing the recess format, such as to before lunch, could improve eating habits. 72

74 Support Materials 7 Joint Position (continued) Improve the Value Placed on Nutrition/School Lunch Program Currently, many School Food Service Programs are paralyzed by financial constraints relative to serving healthier foods. There needs to be increased value placed on the role nutrition plays in our children s health, growth, and academic success. The School Lunch Program should be financially supported, similar to the academic programs in the school, out of school budgets and not required to be self-sustaining or a profit generator for the school. This would reduce the need for serving less healthy foods that provide a greater cash revenue. Additionally, states currently making more dramatic improvement in serving healthy foods are getting a higher state reimbursement rate per meal than schools in Maine. Priority should also be placed on financially supporting health/nutrition educators in the schools and for each district to have a Food Service Director (not just a manager). Ideally, there should be a state-level Director of School Nutrition Services (preferably a registered dietitian) to coordinate what is happening throughout the State and to serve as a statewide resource. There should also be financial compensation for food service employees to obtain certification in nutrition. Food service employees should have time and financial compensation for periodic workshops on nutrition issues, similar to the workshops provided for classroom teachers. At the State level, there should be funds allocated for a sufficient number of qualified personnel to regularly review whether nutrition recommendations are being met by each district. They would also serve as a resource for making improvements. Adequate time should be allotted in the curriculum for health, nutrition, and physical activity education to emphasize their importance as life skills. Knowledge acquired by children from these classes could be elevated academically by including it as part of standardized testing. Conclusion There is already evidence of concern for the short- and long-term health of our children. It is a critical time to take action and prioritize nutrition and physical activity. Our response needs to be a comprehensive approach that involves school administration and staff, parents, and the community. What a great gift we have the chance to give our children the potential for a long and healthy life. 73

75 Support Materials 7 Joint Position (continued) APPENDIX #1 Specific Recommendations for Foods Allowed in Schools Category Foods Not Allowed Foods Allowed Beverages Soft drinks, sports drinks, Low fat and nonfat milk, soy milk, fruit punch, iced tea, other rice milk, and chocolate milk; beverages containing caffeine juices containing > 50% real (except chocolate milk) or added juice; bottled water or seltzer; sugar, juices containing less than other beverages without added 50% real juice. sweeteners (natural or artificial). Entrees/Side Dishes Excessive portions* More than 30% Appropriate portions* of total calories from fat (excluding All fruits, vegetables, legumes/soy fat from nuts, seeds, peanut butter). products, lean animal protein More than 10% of calories from foods, nuts, seeds, peanut saturated fat. More than 35% by butter, low or nonfat dairy products. weight of sugar (excluding sugars occurring naturally in fruit and dairy products). Desserts/Snack Excessive portions* More than 30% Appropriate portions* Foods/Grain Foods of total calories from fat (excluding Lower-fat grain foods (preferably fat from nuts, seeds, peanut butter). whole grain with at least 2 grams More than 10% of calories from fiber) such as some popcorn, saturated fat. More than 35% by some chips, some granola bars, weight of sugar (excluding sugars some crackers, pretzels, low fat/ found naturally in fruit and dairy low-sugar baked goods, low-sugar products). cereals. Snacks or desserts with naturally occurring nutrients such as pudding, trail mix of grains/nuts/seeds and/or dried fruit; 100% fruit popsicles; lowersugar/lower-fat cookies such as animal crackers, graham crackers, oatmeal raisin cookies, fig bars. Miscellaneous Candy, regular chips, chewing gum *See portions defined in Appendix #2. Note Schools should still be aware of the sodium content of foods and try to avoid excess; general guidelines might be to try to limit sodium to < 360 mg per serving (See Appendix #3). 74

76 Support Materials 7 Joint Position (continued) APPENDIX #2 Recommended Portion Limits Item Entrees Beverages (water not limited) Yogurt (not frozen) Frozen Desserts/Ice Cream Bakery Items (such as pastries, muffins, etc.) Cookies/Cereal Bars Snacks/Sweets Such as chips, crackers, popcorn, cereal, trail mix, nuts, seeds, dried fruit, jerky, etc. Maximum Portion Consistent with National School Lunch Program 12 oz. 8 oz. 3 fl. oz. 3 oz. 2 oz oz. 75

77 Support Materials 7 Joint Position (continued) APPENDIX #3 Definition of Healthy Food as defined by the FDA s Nutrition Labeling and Education Act of 1990 Healthy. A healthy food must be low in fat and saturated fat and contain limited amounts of cholesterol and sodium. In addition, if it s a single-item food, it must provide at least 10% of one or more of vitamins A or C, iron, calcium, protein, or fiber. Exempt from this 10% rule are certain raw, canned, and frozen fruits and vegetables and certain cereal-grain products. These foods can be labeled healthy if they do not contain ingredients that change the nutritional profile and, in the case of enriched grain products, conform to standards of identity, which call for certain required ingredients. If it s a meal-type product, such as frozen entrees and multicourse frozen dinners, it must provide 10% of two or three of these vitamins or minerals or of protein or fiber, in addition to meeting the other criteria. The sodium content cannot exceed 360 mg per serving for individual foods and 480 mg per serving for meal-type products. Note: The Nutrition Labeling Act of 1994 defines low fat as < 3 g fat per serving and low saturated fat as < 1 g saturated fat per serving. Recommended Resources Center for Science in the Public Interest (CSPI) School Foods Tool Kit. (http://cspinet.org/schoolfoods) Position of the American Dietetic Association: Local support of nutrition integrity in schools. J Am Diet Assoc. 2000; 100: (www.eatright.org/public/governmentaffairs/92_adap0100.cfm) Position Statement of the American Dietetic Association, Society for Nutrition Education, and the American School Food Service Association Nutrition services: An essential component of comprehensive School Health Programs. J Am Diet Assoc. 2003; 103: (www.eatright.org/public/governmentaffairs/92_8243.cfm) Policy Statement American Academy of Pediatrics, Prevention of Pediatric Overweight and Obesity. Pediatrics. 2003; 112(2): (http://aap.org/policy/s html) California Center for Public Health Advocacy National Consensus Panel on School Nutrition: Recommendations for Competitive Food Standards in California Schools. March (www.publichealthadvocacy.org/school_food_standards/school_food_standards.html) Resolution #10 (2002) Maine Medical Association Curtailing Childhood Obesity. 76

78 Support Materials 7 School Foods Tool Kit Document Summary Suggested Citation: Center for Science in the Public Interest. School Foods Tool Kit. Washington, D.C. September Downloadable Version: Cost: Electronic copy is free. Ordering Information: Center for Science in the Public Interest Nutrition Policy Project 1875 Connecticut Avenue, N.W. Suite 300 Washington, DC (202) Cost: Hard copies are $ What Is This Document About? This Kit is designed to help parents, health professionals, community groups, teachers, and school administrators improve the nutritional quality of the meals, drinks, and snacks available to students. The Kit includes model policies, fact sheets, sample letters, and flyers. It also includes suggestions on how to collaborate with and influence school decision-makers. Highlights and Pages Not to Miss: Page 4 of the kit provides a summary of nutrition standards for foods and beverages sold in school vending machines, a la carte choices, and fund-raising projects. Part II includes clearly written samples for proposing legislation, making presentations to a school board, and talking points for meetings. Pages list many healthy snacks and beverage options for school vending machines. Pages provide many ideas for fund-raising that do not involve food! Please go to the CSPI Web site (www.cspinet.org/schoolfoods) to access Part III. Part III is maintained on their Web site so timely updates can be made. You ll find wonderful examples from states that have succeeded in improving the nutritional quality of food offered to students, as well as examples from schools that have changed their vending machine policies. Check out the two examples from Maine! Maine School Administrative District #22 and School Union #106 are showcased for their successful vending machine changes. 77

79 Vending Machine Policy Packet The Soda/Snack Vending Machine Policy Initiative Background and History In March of 2002, the Maine Bureau of Health s Oral Health Program, the Maine Dental Association, and the Maine Center for Public Health convened a meeting of interested organizations and individuals to discuss health concerns related to the consumption of soda and other non- or low-nutritive snacks among young people. The meeting was attended by 15 people with seven others expressing interest but unable to attend. By the summer of 2002, the Soda/Snack Vending Machine Policy Initiative committee had grown to 25 people with individuals representing a variety of organizations including schools, community coalitions, State-level organizations, and universities. A list of partners is included in this packet. At the conclusion of the first meeting, the committee decided to promote policies for school vending machines that would replace nonnutritious foods and beverages with more nutritious alternatives. To accomplish this, the group would develop a model policy, identify pilot sites, evaluate the program, and then disseminate the model statewide. Policy Development A policy work group was formed and given the charge to draft a model policy for the larger committee to review. This work group included expertise from dietitians, dentists, hygienists, and other public health professionals. The work group reviewed existing policies and found that the majority of the policies did not go far enough to meet the goals of the initiative. They decided to develop their own model policy that was guided by examples from the Centers for Disease Control and Prevention as well as by other national guidelines and recommendations. This policy was reviewed by the full committee and revised multiple times. The purpose of the model policy is to be used as a guide for schools interested in passing a soda/snack vending machine policy. It is expected that the policy will be adapted to fit the needs of the community. Packets In order to assist pilot sites and others in the future, the committee developed packets that included fact sheets with health information based on available research and other support materials. As the pilot sites complete their work, the packets will be revised and enhanced to be as useful as possible. 78

80 Vending Machine Policy Packet The Soda/Snack Vending Machine Policy Initiative (continued) Evaluation As an optional benefit, Janet Whatley Blum, Ph.D., from the University of Southern Maine received a small research grant to conduct an evaluation of the project using two intervention sites and two control sites. The evaluation will look at the policy-making process, the effect on sales, as well as the impact on specific health measures for the youth impacted by the policy change. 79

81 Vending Machine Policy Packet Model School Vending Machine Policy I. Purpose of the Policy To improve the health of our children by promoting healthy food and beverage choices by replacing nonnutritious foods and beverages with more nutritious choices in vending machines. II. Rationale When children are taught in the classroom about good nutrition and the value of healthy food choices but are surrounded by vending machines, snack bars, school stores, and a la carte sales offering low-nutrient density options, they receive the message that good nutrition is merely an academic exercise that is not supported by the school administration and is therefore not important to their health or education. (Foods Sold in Competition with USDA School Meal Programs. U.S. Dept. of Agriculture 2001.) The health of our children is of utmost importance to the future of our society. As great progress has been made toward understanding and treating many diseases, society is also recognizing the importance of establishing preventive health habits early in life in order to reduce the risks of developing diet-related diseases. Many chronic diseases, including heart disease, diabetes, osteoporosis, and cancer, are related to lifestyle risk factors including poor nutrition and physical inactivity. According to the U.S. Surgeon General, overweight and obesity are at epidemic proportions. The prevalence of overweight among youth ages 6-17 years in the U.S. has more than doubled in the past 30 years; most of the increase has occurred since the late 1970s. Overweight children and adolescents are much more likely to develop Type 2 diabetes and to become overweight adults with increased risk for developing heart disease and stroke; gallbladder disease; arthritis; and endometrial, breast, prostate, and colon cancers. Left unabated, the Surgeon General states overweight and obesity may soon cause as much preventable disease and death as cigarette smoking. As stated in Oral Health America: A Report of the U.S. Surgeon General, tooth decay continues to be the single most common chronic childhood disease. The connection between tooth decay and the consumption of foods high in sugar has long been known. Untreated oral diseases can interrupt a child s normal development and learning. Early tooth loss caused by dental decay can result in failure to thrive, impaired speech development, absence from school, inability to concentrate in school, and a low self-esteem. Poor oral health has been related to decreased school performance, poor social relationships, and less success later in life. Children experiencing pain are distracted and unable to concentrate on schoolwork. Oral health is integral to children s overall health and well-being. 80

82 Vending Machine Policy Packet Model School Vending Machine Policy (continued) According to the Center for Science in the Public Interest, as teens have doubled or tripled their consumption of soft drinks, they cut their consumption of milk, an important source of calcium, by more than 40%. Few teens consume the recommended amount of calcium. Getting enough calcium in the diet during childhood, adolescence, and young adulthood is essential to reduce the risk for osteoporosis later in life. This is particularly important for females. While many people believe that addressing nutrition-related problems is a personal responsibility, they are only partially correct. It is also a community responsibility and schools have been identified as key settings to both teach and model responsible health behavior. In the October 2001 Call to Action to Prevent and Decrease Overweight and Obesity, the Surgeon General of the United States specifically recommends that schools adopt policies ensuring that school environments contribute to eating patterns consistent with the Dietary Guidelines for Americans While often schools struggle to raise needed funds, financial considerations should be secondary to the health and well-being of our children. III. Definitions (adapted from U.S. Food and Drug Administration Nutrition Labeling and Education Act of 1990 (NLEA)) Juice is defined as 100 percent fruit/vegetable juice and that information must be included on the label. Low fat items are defined as 3 grams or less of fat per serving. Low saturated fat is defined as 1 gram or less of saturated fat per serving. Healthy food is defined as follows: Must be low in fat (3 grams or less per serving) and low in saturated fat (1 gram or less per serving) and contain limited amounts of cholesterol (60 mg or less per serving) and sodium (cannot exceed 360 mg per serving). Foods that are not raw fruits or vegetables must provide at least 10 percent of the daily value of one or more of the following nutrients per serving: vitamin A, vitamin C, iron, calcium, protein, and fiber. Exempt from this 10% rule are certain raw, canned, and frozen fruits and vegetables and certain cereal-grain products. Water should not contain sugar or added caffeine or other ingredients. Low-sugar cereal (defined by Women, Infants, and Children s Nutrition Program (WIC) and Child and Adult Care Food Program (CACFP)) as 6 grams of sugar or less per 100 grams of cereal. 81

83 Vending Machine Policy Packet Model School Vending Machine Policy (continued) Foods of minimal nutritional value (a) in the case of artificially sweetened foods, a food which provides less than 5% of the Reference Daily Intake for each of eight specified nutrients per serving; (b) in the case of all other foods, a food which provides less than 5% of the RDI for each of eight specified nutrients per 100 calories and less than 5% of the RDI for each of eight specified nutrients per serving. The eight nutrients to be assessed for this purpose are protein, vitamin A, vitamin C, niacin, riboflavin, thiamin, calcium, and iron. Authority: 20MRSA Section 6602(5) **Note: Schools that participate in the National School Lunch Program must meet the criteria for foods of minimum nutritional value. IV. Vending Machine Policy In all schools within the district, only items on the sample list for school vending machines from the Centers for Disease Control and Prevention(CDC), and that meet or exceed the 5% minimum nutritional value rule (see Section III.), and water shall be sold in any school vending machine at any time of the day or evening. If items other than those on the CDC sample list are to be sold, they must first be approved by (identify school personnel/committee assigned to this task) and meet the definition of a healthy food. Allowable vending machine items include: Beverages Fruit juice and vegetable juice (100%) Low fat (1%) or skim milk Water Snacks Canned fruit (packed in 100% juice/no sugar added) Fresh fruit (e.g. apples and oranges) Fresh vegetables (e.g. carrots) Low fat crackers and cookies, such as fig bars and ginger snaps Pretzels Bread products (e.g. bread sticks, rolls, bagels, and pita bread) Ready-to-eat, low-sugar cereals (6 grams sugar or less per 100 grams cereal) 82

84 Vending Machine Policy Packet Model School Vending Machine Policy (continued) Granola bars made with unsaturated fat Low fat or nonfat yogurt Snack mixes of cereal and dried fruit with a small amount of nuts and seeds* (low-sugar cereal) Raisins and other dried fruit* (No sugar added) Peanut butter and low fat crackers** *Some schools might not want to offer these items because these foods can contribute to tooth decay. **Some schools might not want to offer peanut butter; although it is low in saturated fatty acids, peanut butter is high in total fat. Optional Sections V. Soda Pouring Rights Contracts The school shall not enter into a contract with any soda company that requires items to be sold in vending machines other than those from the Vending Machine Policy, Section IV. VI. Food Sold during Fund-Raising Activities To create a school environment that supports the promotion of healthy food and beverage choices for children, it is important to consider all venues where food and beverages are sold. These venues include fund-raising, fund-raising events, concession stands at sporting and other events, school stores, and a la carte meal items. The following recommendations are made to promote healthy choices for children related to fund-raising activities supported by the school. Offer only non-food items as the items that raise funds such as books, gift wrap, candles, plants, flowers, school promotional items, etc. Whenever food and beverages are sold that raise funds for the school, include food and beverage choices from the Vending Machine Policy, Section IV. Whenever food and beverages are offered in celebration or support of school fund-raising activities, include food and beverage choices from the Vending Machine Policy, Section IV. 83

85 Vending Machine Policy Packet Model School Vending Machine Policy (continued) VII. Advertising Except as permitted in subsection (d), it shall be unlawful for any public school in this district, or any other entity or person acting on behalf of any public school in this district to: Enter into a contract that grants exclusive advertising of any product or service through out the district to a person, business, or corporation; Enter into a contract or permit a school within the district to enter into a contract for prod ucts or services that requires the dissemination of advertising to pupils, including logos on facilities or informational equipment such as a scoreboard or banner with an educational message, or allow any person, corporation, or business to gather or obtain information from students for the purposes of market research. Contracts entered into prior to the operative date of this policy may not be renewed if they conflict with this policy. Nothing in this policy shall affect the ability of any public school in this district, or any other entity or person acting on behalf of any public school in this district to: (1) publicly advertise in any school newspaper, other school periodical, Web pages, or yearbook, (2) distribute advertising or market research as part of curriculum on advertising, marketing, media literacy; or, (3) post signs indicating the public s appreciation for financial or other support from any person, business, or corporation for the educational program in any school district. The term advertising means the commercial use, by any person, company, business, or corporation of any media including, but not limited to, newspaper or other printed material or flyer or circular, radio, television, video or any other electronic technology, outdoor sign, or billboard in order to transmit a message with information: offering any good or service for sale, or for the purpose of causing or inducing any other person to purchase any good or service, or that is directed toward increasing the general demand for any good or service. 84

86 Vending Machine Policy Packet Evaluation Study of a Snack/Soda Policy in Schools Aims of the study: 1. To examine sales and/or profits of vending machines offering only items on the sample list for school vending machines from the CDC and water versus vending machines offering other foods and beverages. 2. To examine if changing only foods and beverages offered in vending machines to only items on the sample list for school vending machines from the CDC and water will impact the diet quality of high school students. Secondary Aims of the study: 1. To determine relationships among changes in dietary quality and other health indicators in high school students. These include body weight, bone mineral density status, oral health and physical activity levels. Requirements of both the control & intervention school: 1. Support from administration, food service personnel, faculty, etc. 2. Information on a monthly basis (or whatever time frame is appropriate) regarding profits and specific food items sold in vending machines. 3. Ability to recruit approximately 100 volunteer students. Recruitment strategies would include presentations in PE/Health or science classes; fliers throughout the school or sent home to parents; and possible presentation to administration, faculty staff, and parents. Students willing to volunteer would need parental consent and their own assent prior to participation. 4. Access to study volunteers two times, once during the spring of 2003 and once during the spring of 2004 for measurements. Measurements would take approximately 45 to 60 minutes per volunteer and could be done before or after school or during a study hall. Subject volunteer would receive tokens (water bottle, etc.) at each measurement period. Measurements include: a. Height and weight (need access scale) b. Completion of a food frequency questionnaire c. Completion of a physical activity questionnaire Optional measurements: a. Asking subject to open their mouth for a trained researcher to examine their teeth b. Asking subject to place their hand in a DEXA machine to take an X-ray of their middle finger 85

87 Vending Machine Policy Packet Evaluation Study of a Snack/Soda Policy in Schools (continued) Specific to the CONTROL SCHOOL: 1. Agreement not to make any changes in the current food or beverage choices of vending machines at the school for the study period (from spring of 2003 to spring of 2004). Specific to the INTERVENTION SCHOOL: 1. Agreement to replace food and beverage choices in all school vending machines to choices that are consistent with the items on the sample list for school vending machines from the CDC and water for the 2003/2004 school year. 86

88 Vending Machine Policy Packet Soda/Snack Initiative Partner List Dr. Wendy Alpaugh, Maine Dental Association Maureen Andrew, Edward Little High School, School Based Health Center Christine Arnaudin, Communities Promoting Health Dheeraj Bansal, Maine Center for Public Health Linda Christie, ACCESS Health Mary Dechene, Maine Dental Hygienist s Association Judy Gatchell, Maine Nutrition Network Sandra Hale, School Health Coordinator, Westbrook Lucinda Hale, Bureau of Health, Diabetes Control Program Merry Harkins, Home Economics Teacher/Bath Middle School Martin Hayden, Medical Care Development Diana Hixon, School Nurse, Bath Middle School Mary Jo Hodgkin, School Health Coordinator/Auburn School Lori Kaley, USM, Muskie School Janet Leiter, Bureau of Health/Maternal and Child Health Nutrition Program Ann London, PTA President Mary Moody, Maine Department of Education Karen O Rourke, Maine Center for Public Health Kristine Perkins, Bureau of Health, Oral Health Program Sara Platt, Maine Dairy & Nutrition Council Barbara Raymond, Director, Augusta School Nutrition Programs Emily Rines, Coastal Healthy Communities Lucie Rioux, Communities Promoting Health Amy Root, Maine Nutrition Network Dr. Michael Schoelch, Maine Dental Association Joyce Severance, School Nurse, Lisbon Falls Michelle Small, American Cancer Society Richard Veilleux, Healthy Portland Janet Whatley Blum, USM Sports Medicine Department Debra Wigand, Bureau of Health, Maine Cardiovascular Health Program 87

89 Vending Machine Policy Packet Contacts For Further Information : Lori Kaley Maine Nutrition Network 295 Water Street Augusta, ME Phone: Mary Moody Maine Department of Education 32 State House Station Augusta, ME Phone: Karen O Rourke Maine Center for Public Health 12 Church Street Augusta, ME Phone: Kristine Perkins Bureau of Health / Oral Health Program 11 State House Station Key Plaza 4th Floor Augusta, ME Phone: Amy Root Maine Nutrition Network 295 Water Street Augusta, ME Phone:

90 Vending Machine Policy Packet Body Weight and Sugar Body Weight Facts Since 1980, obesity has doubled among adults and overweight has tripled among adolescents. Weight gain results from taking in too many calories from foods and drinks and not using enough calories through physical activity. Overweight is defined for youth as being at or above the 95th percentile for Body Mass Index (BMI) by age and sex based on reference data from the National Health and Nutrition Examination Survey. Check your BMI at Overweight in youth can lead to obesity in adulthood. Obesity is an important risk factor for increased heart disease, diabetes, some cancers, and arthritis. Among youth, adult onset diabetes has increased tenfold in the past five years. Maine Youth In 2001, 10% of Maine high school students were overweight and 15% were at risk for becoming overweight. This is similar to national rates. More Maine males than females were overweight (15% of males / 6% of females) and more males than females were at risk for becoming overweight (17% of males / 12% of females). Sugar Facts Diets high in sugar have been associated with increased risk of obesity. The largest source of added sugar in the U.S. diet is regular soft drinks (33%). Other major sources of added sugar in the U.S. diet are sweets and candy (16%) and sweetened grains such as cookies and cakes (13%). Adolescents ages 12 to 17 get almost 40% of the added sugar in their diets from soft drinks. Over the past 20 years, teens have nearly tripled the amount of soda they drink. Soft Drinks and Body Weight Overweight youth consumed more calories from soft drinks compared to normal weight youth. Teenaged boys consumed the greatest amount of calories from soft drinks. A link between the consumption of sugar-sweetened drinks and obesity has been found in teenagers. The National Institutes of Health recommends that people who are trying to lose or control their weight should drink water instead of soft drinks with sugar. 89

91 Vending Machine Policy Packet Bone Health and Soda Bone Health Facts Osteoporosis, or porous bone, is a disease in which bones become fragile and are more likely to break. Because peak bone mass is attained by age 25, it is important that children get the calcium they need during these bone-building years. The beverage consumption habits of youth may lead to obesity and osteoporosis. Building Better Bones Calcium from food becomes part of the bones framework. The more calcium the bones contain, the stronger and more dense they will be. Vitamin D helps the body absorb calcium from food and helps deposit the mineral into your bones. Not taking in enough calcium & vitamin D and not doing enough weight-bearing exercise contribute to osteoporosis. Youth and Calcium Between Grade 3 and Grade 8, children increase the amount of soda they drink by four times. During this same time, the amount of milk they drink goes down. During teen years, bones are in their most active growth phase. Nearly half of all bone is formed and about 15% of adult height is added at this time. Nearly 90% of teen girls and almost 70% of teen boys do not get enough calcium. On average, teens drink only one glass of milk a day. Today s teens have tripled the amount of soda they drink and have cut their consumption of milk by more than 40%. 90

92 Vending Machine Policy Packet Tooth Decay and Sugar Tooth Decay Facts Tooth decay is the most common chronic childhood disease in the U.S. five times more common than asthma and seven times more common than hay fever. An estimated 51 million hours of school are lost each year in the U.S. due to dental-related illness. Untreated oral diseases can interrupt a child s normal development and learning. There are safe and very effective ways to prevent most tooth decay. Diet and nutrition have a direct effect on tooth decay. Sugar Facts Diets high in sugar have been identified as a major cause of tooth decay. The most common cause of tooth decay is the consumption of soft drinks, candy, cakes, cookies, and other sweet pastries. Over the past 20 years, teenagers have nearly tripled the amount of soft drinks they drink. About 40% of the sugar in their diets is from soft drinks. Sugar accounts for 50% of daily food intake in the average American diet. Small amounts of sugary foods eaten frequently during the day are the most dangerous. Each time sugar is consumed, acid that causes tooth decay is produced. Other Important Facts Tooth decay is an infectious disease caused by certain types of bacteria. Fluoride can help prevent tooth decay by making the outer surface of teeth stronger and more resistant to the acid that causes tooth decay. Keeping your teeth clean by brushing and flossing daily will help to prevent tooth decay and gum disease. 91

93 Vending Machine Policy Packet Fact Sheet References Body Weight and Sugar Cavadini, C., Siega-Riz, A.M., & Popkin, P.M. (2000). I.S. Adolescent food intake trends from 1965 to Archives of Diseases/Children, 83, Embrace Your Health! Lose Weight If You Are Overweight, NHLBI and Office of Research on Minority NIH Publication No , Sept Ludwig, D.D. Peterson, K.E., & Gortmaker, S.L. (2001). Relation between consumption of sugarsweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357, Troiano, R.P., Briefel, R.R., Carroll, M.D., & Bisolstosky, K. (2000). Energy and fat intake of children and adolescents in the United States. Data from the National Health and Nutrition Surveys. American Journal of Clinical Nutrition, Supplement 1343S-1353S. Bone Health Wyshak, G., Teenaged girls, carbonated beverage consumption, and bone fractures. Archives of Pediatric Adolescent Medicine 2000, 154: 610. Lytle, L.A., et al. How do children s eating patterns and food choices change over time? American Journal of Health Promotion 2000, 14: 222. Tooth Decay and Sugar U. S. Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General. Rockville, MD, Gift, H.C., Oral Health Outcomes Research: Challenges and Opportunities. In Slade G.D., ed., Measuring Oral Health and Quality of Life pp Chapel Hill NC: Department of Dental Ecology, University of North Carolina. Office of Disease Prevention and Health Promotion Healthy People Cited January 15, 2001; available at: 2/21Oral.html-Toc Joint Report of the American Dental Association Council on Access, Prevention, and Interprofessional Relations and Council on Scientific Affairs to the House of Delegates: Response Resolution 73H October

94 Vending Machine Policy Packet Publicity for Local Soda/Snack Initiatives There are many ways to publicize your health messages, events, and activities. Here are ideas that will help you get your messages placed: Local News Outlets Develop a list of local newspapers, radio and television stations. Many libraries have media directories that include addresses, phone numbers, names of editors or producers, and circulation or broadcast information. The local phone directory is a good resource for locating news outlets. Don t overlook community news or free papers, that often print upcoming community events. Press Releases These are bulletins that provide general information about specific topics (the role of sugar in diets, childhood obesity, dental decay), or an upcoming event such as a health fair. News articles should be typed double-spaced and if applicable on letterhead. Good outlets for news releases include: Daily and weekly newspapers Shopping guides Community newsletters Library bulletin boards Health club newsletters Church bulletins Chamber of Commerce newsletters Sample Press Releases A sample press release highlighting a local initiative to decrease sugar consumption among youth is included in this kit as a reference. Creating Your Own Press Release A press release should always include the five W s: Who, What, When, Where, and Why. The spokesperson or contact name and phone number should appear in the upper right corner of the release. Date the release and include the city, state to indicate when and where the release was issued. Double-space type and at the bottom of each page indicate if there is more copy (-more-) or if the release has ended type (# # #) at the bottom. Check the local newspaper Web sites. Many papers accept s announcing local community events. 93

95 Vending Machine Policy Packet Publicity for Local Soda/Snack Initiatives (continued) Sample Newspaper Articles Sample articles in this kit may be published as a public service to the community. You may wish to add quotes or information to expand on the contents in the samples. Send a brief letter or to community affairs editors informing them about your local initiative. Explain that the news articles were prepared as a public service to the community. Follow up with a call to the editor to determine if and when the articles might be placed or whether further information is required. Placing your school s name and the spokesperson s name in the copy will customize the attached samples. The articles may be useful when promoting school events. As an example, an article on sugar related to health can help publicize an upcoming health fair. When sample articles are used, it is inappropriate for an individual to have the articles published under their name, implying authorship. Announcer-Read Copy Sample scripts are enclosed for use by local radio stations. Type the scripts on school letterhead and insert the spokesperson s name. Send the scripts to public service directors and local radio stations. Public service announcements are broadcast without charge. Consequently, stations schedule them at their own discretion. A letter or call to the station may give you an idea of the broadcast date. Broadcasting Local radio and TV programs often have talk shows, call-in programs, or special features, such as consumer interest spots. Contact the show s producer, program director, and/or host regarding your dental topics and to offer a spokesperson. Many dental and medical societies may participate in ask the doctor programs on local radio stations. Begin to contact the media well in advance (two months) to make arrangements. Copyrights Although materials obtained from professional organizations may be camera-ready, and may be reproduced, please review the guidelines and restrictions established by the organization before any materials are duplicated. Any specific questions should be directed to the particular organization. 94

96 Vending Machine Policy Packet Sample Press Release modify as needed FOR IMMEDIATE RELEASE (Date) Shed Some Light on Soda and Snacks FOR INFORMATION CONTACT: (Your Spokesperson s name) (Phone number) (City, State) Children who regularly drink sugary soda and eat sugary snacks are at a higher risk of becoming obese and getting tooth decay. Many diseases including heart disease, diabetes, osteoporosis, and cancer are related to lifestyle risk factors including poor nutrition and physical inactivity. (Insert quote from local spokesperson) Over the past 20 years, teens have nearly tripled the amount of soda they drink and have cut their consumption of milk by almost half. The average child drinks more than one can of soda every day. Boys ages drink the most soda, more than two cans every day. Children are drinking soda and eating sugary snacks instead of healthy foods, juice, and milk. Many sugary foods and drinks are easily available to school-aged children through vending machines in schools. Parents, health officials, and school administrators need to recognize that poor nutrition is a major health concern for children. Soda and sugary snacks should return to their former role as occasional treats. Recommendations for change may include: Setting school policies that ensure students have more access to healthy drinks and snacks. Prohibiting soda contracts in schools. Eliminating school advertising and promotional events that promote unhealthy snack and beverage choices. Funding school and student activities so they do not have to rely on students purchasing and eating sugary foods and drinks to fund educational and extracurricular needs. While schools often struggle to raise needed funds, financial considerations should be secondary to the health and well-being of our children. Invest in Healthy Maine Children! ### 95

97 Vending Machine Policy Packet How to Create and Implement Policy Lay the Groundwork Needs assessment: Compile statistics Survey Clarify the objective: Is there another policy/program already addressing the issue? Is a new policy needed or do you just need to revise an existing one? Review the foundation policies: Become familiar with processes and procedures usually used to develop and pass a policy. Collect information: Current scientific and medical findings, resource materials, and success stories. Write a policy proposal: Write a brief description of the issues based on the information you ve collected. Identify reasons for new/revised policy. Outline several policy options from which policy-makers can choose. Become familiar with the political dynamics: Anticipate who may be supportive and who may oppose. Devise an appropriate strategy to get a policy adopted/advised: Seek advice on the best ways to approach policy-makers (individually or as a whole). Respect the hierarchy: Don t work behind the back of your school administrators. Build Awareness and Support Involve those affected by the policy. Involve other youth-serving agencies (YMCA, YWCA, 4-H, Boys & Girls Clubs, recreation departments, and social service agencies). Involve people from a variety of community groups, business leaders, and private sector employees (Chamber of Commerce, service organizations, PTA). Anticipate, respond to, and involve critics: Provide speaking points if necessary. Consider inviting opponents to policy-making process. Apply communication strategies as needed: Increase public awareness of the need for proposed policy. 96

98 Vending Machine Policy Packet How to Create and Implement Policy (continued) Draft the Policy Officially bring the policy proposal to the attention of the decision-making body (e.g. state/local school board) for the go-ahead to proceed. Policy-drafting committee should consist of: Family members of students. Teachers & administrators. School health staff, pupil services personnel, food service personnel. Middle / high school students to provide a reality check. *A collective bargaining agreement may require that an official of the teachers association or school employee union be involved in the policy development process. Prepare an action timeline for the committee. Arrange for short presentations from credible experts for policy-drafting committee members to pose questions and express concerns and perspectives. Stay focused on the big picture, don t get caught up in the details. Draft the policy language: Be clear, simple, specific, and accurate and avoid education, health, and legal jargon. Be concise and brief. Include a rationale for the policy, describe the benefits of adopting it. Be consistent with state, district, and school visions for student learning, education reform efforts, and other current initiatives. Build in accountability: cite who will be responsible for doing what and describe mechanisms for ongoing enforcement. Ensure that the policy provides practical guidance to school staff members and how to address specific issues. Include provisions for policy evaluation and periodic review. Allow time for committee members to share the draft policies with their constituencies, gather reactions, and report back to the full committee. Conduct public hearings or other means of gathering public input as required by the established policy-making procedures. 97

99 Vending Machine Policy Packet How to Create and Implement Policy (continued) Adopt the Policy Present the final draft along with useful background information and get a well-known and respected person onto the agenda to make a persuasive case for the policy. Administer the Policy Implement the policy. Implement a proactive communications plan to inform, educate, and build support for the policy among school staff, families and students, and the community. Stress the benefits, prepare fact sheets, talking points, and other written materials. Maintain the effort after the initial push for implementation. Typical Policy Components Authority: Who is establishing the policy; what legal authority underlies it? Rationale: Why this policy is necessary? Priority population: To whom does the policy apply? Definitions: To avoid confusion, include clear explanations of major terms used. Activities: The heart of the policy should describe how the program would be conducted, the strategy to deal with a particular situation, and the requirements that staff must follow. Administration: Who enforces the policy and how? Consequences: The rewards and sanctions that provide positive and negative incentives for compliance with the policy. Evaluation: How the policy s effect will be measured and how that information will be used. Duration: When the policy is adopted, when it takes effect, and when it expires. Adapted from Fit, Healthy and Ready to Learn National Association of State Boards of Education March

100 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health Michael F. Jacobson, Ph.D. Links : Soft Drinks and Health CSPI News Releases CSPI Documents Library Table of Contents: Soaring Consumption of Soft Drinks Nutritional Impact of Soft Drinks Health Impact of Soft Drinks Aggressive Marketing of Soft Drinks Recommendations for Action In 1942, when production of carbonated soft drinks was about ounce servings per person, the American Medical Association s (AMA) Council on Foods and Nutrition stated: From the health point of view, it is desirable especially to have restriction of such use of sugar as is represented by consumption of sweetened carbonated beverages and forms of candy which are of low nutritional value. The Council believes it would be in the interest of the public health for all practical means to be taken to limit consumption of sugar in any form in which it fails to be combined with significant proportions of other foods of high nutritive quality. 1 By 1998, soft drink production had increased by nine-fold (Figure 1) and provided more than one-third of all refined sugars in the diet, but the AMA and other medical organizations now are largely silent. This review discusses the nutritional impact and health consequences of massive consumption of soft drinks, 2 particularly in teenagers. Figure 1. Annual soft drink production in the U.S. (12-ounce cans per person) National Soft Drink Association; Beverage World 99

101 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health (continued) Soaring Consumption of Soft Drinks Carbonated soft drinks account for more than 27% of Americans beverage consumption. 3 In 1997, Americans spent over $54 billion to buy 14 billion gallons of soft drinks. That is equivalent to more than ounce servings per year or ounce cans per day for every man, woman, and child. 4 That is also more than twice the amount produced in Artificially sweetened diet sodas account for 24% of sales, up from 8.6% in Table 1. Consumption of non-diet soft drinks by 12- to 19-year-olds (ounces per day) and percent of caloric intakes (all figures include nondrinkers). Year Ounces per day Percent of calories boys girls boys girls Calculated from U.S. Department of Agriculture Nationwide Food Consumption Survey, ; Individual, , Continuing Survey of Food Intakes by Children start drinking soda pop at a remarkably young age and consumption increases through young adulthood. One fifth of one- and two-year-old children consume soft drinks. 6 Those toddlers drink an average of seven ounces nearly one cup per day. Toddlers consumption changed little between the late 1970s and mid 1990s. Table 2. Consumption of regular and diet soft drinks by 12- to 19-year-olds (excludes nondrinkers). Year Ounces per day boys girls U.S. Department of Agriculture Nationwide Food Consumption Survey, ; Continuing Survey of Food Intakes by Individual, ,

102 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health (continued) Almost half of all children between 6 and 11 drink soda pop, with the average drinker consuming 15 ounces per day. That s up slightly from 12 ounces in The most avid consumers of all are 12- to 29-year-old males. Among boys 12 to 19, those who imbibe soda pop drink an average of almost ounce sodas (28.5 ounces) per day. Teenage girls also drink large amounts of pop. Girls who drink soft drinks consume about 1.7 sodas per day. (Women in their twenties average slightly more: two 12-ounce sodas per day.) (See Tables 1 and 2) In a new analysis of diet-intake data, soft drink consumption by 13- to 18-year-olds was examined (the results cannot be compared directly to the data shown for 12- to 19-year-olds because slightly different methods were used). This analysis identified how much soda pop is consumed by how many teens. For instance, one-fourth of 13- to 18-year-old male pop drinkers drink 21 2 or more cans per day, and one out of 20 drinks five cans or more. 7 (See Table 3) One-fourth of 13- to 18-year-old female pop drinkers drink about two cans or more per day, and one out of twenty drinks three cans or more. 8 (Actual intakes may well be higher, because many survey participants tend to underestimate quantities of bad foods consumed.) Table 3. Consumption of regular and diet soft drinks by 13- to 18-year olds (ounces per day; excludes nondrinkers) percentiles ; boys, ; girls, ; boys and girls Percentile calculations by Environ, Inc.; data from USDA, CSFII, Figures for calculated from P.M. Guenther, Journal of the American Dietetic Association 1986;86: By contrast, twenty years ago, the typical (50th-percentile) 13- to 18-year-old consumer of soft drinks (boys and girls together) drank 3 4 of a can per day, while the 95th-percentile teen drank cans. That s slightly more than one-half of current consumption. 101

103 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health (continued) One reason, aside from the ubiquitous advertising, for increasing consumption is that the industry has steadily increased container sizes (Figure 2). In the 1950s, Coca-Cola s 61 2-ounce bottle was the standard serving. That grew into the 12-ounce can, and now those are being supplanted by 20-ounce bottles (and the 64-ounce Double Gulp at 7-Eleven stores). The larger the container, the more beverage people are likely to drink, especially when they assume they are buying single-serving containers. Also, prices encourage people to drink large servings. For instance, at McDonald s restaurants a 12-ounce ( child size ) drink costs 89 cents, while a drink 250% larger (42-ounce super size ) costs only 79% more ($1.59).9 At Cineplex Odeon theaters, a 20-ounce ( small ) drink costs $2.50, but one 120% larger (44-ounce large ) costs only 30% more ($3.25). 10 Nutritional Impact of Soft Drinks Regular soft drinks provide youths and young adults with hefty amounts of sugar and calories. Both regular and diet sodas affect Americans intake of various minerals, vitamins, and additives. Sugar Intake Carbonated drinks are the single biggest source of refined sugars in the American diet. 11 According to dietary surveys, 12 soda pop provides the average American with seven teaspoons of sugar per day, out of a total of 20 teaspoons. Teenage boys get 44% of their 34 teaspoons of sugar a day from soft drinks. Teenage girls get 40% of their 24 teaspoons of sugar from soft drinks. Because some people drink little soda pop, the percentage of sugar provided by pop is higher among actual drinkers. 102

104 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health (continued) The U.S. Department of Agriculture (USDA) recommends that people eating 1,600 calories a day not eat more than six teaspoons a day of refined sugar, 12 teaspoons for those eating 2,200 calories, and 18 teaspoons for those eating 2,800 calories. 13,14 To put those numbers into perspective, consider that the average 12- to 19-year-old boy consumes about 2,750 calories and cans of soda with 15 teaspoons of sugar a day; the average girl consumes about 1,850 calories and one can with ten teaspoons of sugar. Thus, teens just about hit their recommended sugar limits from soft drinks alone. With candy, cookies, cake, ice cream, and other sugary foods, most exceed those recommendations by a large margin. Calorie Intake Lots of soda pop means lots of sugar means lots of calories. Soft drinks are the fifth largest source of calories for adults. 15 They provide 5.6% of all the calories that Americans consume. 16 In 12- to 19-year-olds, soft drinks provide 9% of boys calories and 8% of girls calories. 17 Those percentages are triple (boys) or double (girls) what they were in (See Table 1) Those figures include teens who consumed little or no soda pop. For the average 13- to 18-year-old boy or girl soda drinker, soft drinks provide about 9% of calories. Boys and girls in the 75th percentile of consumption obtained 12% of their calories from soft drinks, and those in the 90th percentile about 18% of their calories. Nutrient Intakes Many nutritionists state that soft drinks and other calorie-rich, nutrient-poor foods can fit into a good diet. In theory, they are correct, but, regrettably, they ignore the fact that most Americans consume great quantities of soft drinks and meager quantities of healthful foods. One government study found that only 2% of 2- to 19-year-olds met all five federal recommendations for a healthy diet. 18 USDA s Healthy Eating Index found that on a scale of 0-100, teenagers had scores in the low 60s (as did most other age-sex groups). Scores between 51 and 80 indicate that a diet needs improvement. 19 Dietary surveys of teenagers found that in 1996: Only 34% of boys and 33% of girls consumed the number of servings of vegetables recommended by USDA s Food Pyramid. Only 11% of boys and 16% of girls consumed the recommended amount of fruit. Only 29% of boys and 10% of girls consumed the recommended amount of dairy foods. Most boys and girls did not meet the recommended amounts of grain and protein foods. 103

105 Vending Machine Policy Packet Liquid Candy How Soft Drinks Are Harming Americans Health (continued) Those surveys also found that few 12- to 19-year-olds consumed recommended amounts of certain nutrients, including: calcium: only 36% of boys and 14% of girls consumed 100% of the Recommended Dietary Allowance (RDA). vitamin A: only 36% of boys and 31% of girls consumed 100% of the RDA. magnesium: only 34% of boys and 18% of girls consumed 100% of the RDA. As teens have doubled or tripled their consumption of soft drinks, they cut their consumption of milk by more than 40%. Twenty years ago, boys consumed more than twice as much milk as soft drinks, and girls consumed 50% more milk than soft drinks (Figure 3). By , both boys and girls consumed twice as much soda pop as milk (and 20- to 29-year-olds consumed three times as much). Teenage boys consumed about 2 2/3 cups of carbonated soft drinks per day but only cups of fluid milk. Girls consumed about cups per day of soft drinks, but less than 1 cup of milk. Compared to adolescent nonconsumers, heavy drinkers of soda pop (26 ounces per day or more) are almost four times more likely to drink less than one glass of milk a day. 20 In , teenage boys and girls who frequently drank soft drinks consumed about 20% less calcium than nonconsumers. Heavy soft-drink consumption also correlated with low intake of magnesium, ascorbic acid, riboflavin, and vitamin A, as well as high intake of calories, fat, and carbohydrates. 21 In , calcium continued to be a special problem for female soft drink consumers. 22 Figure 3. Teens (ages 12-19) consumption of milk and soft drinks (ounces per day). USDA: NFCS, CSFII 104

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