Develop Policies that Support
Healthy Options in Vending Machines
Action Packet
Action Packet
Develop Policies that Support Healthy Options in
Vending Machines
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 #: 014-10A-0953-022
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 04333.
(207) 287-8015 or 1-800-438-5514 (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.
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Action Packet
Develop Policies that Support Healthy Options in
Vending Machines
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Section 3—Real Maine Examples
• Bath Iron Works (BIW) Vending Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
• Casco Bay YMCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
• L.L.Bean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
• Lisbon Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
School Administrative District (MSAD) #22: Hampden,
• Maine
Newburgh, Winterport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
• Old Orchard Beach (OOB) Schools Vending Policy . . . . . . . . . . . . . . . . . . . . . . . . . . .15
• Maine School Administrative District (MSAD) #75: Mt. Ararat High School . . . . . . .17
• School Union #106: Robbinston, Calais, Alexander, Baring Plantation, Crawford . . . .19
Section 4—Action Steps
• Action Steps: To Guide Your Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
• Step 1—Stock Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
• Step 2—Go Browsing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
• Step 3—Dispense Ideas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
• Step 4—Push the Right Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
• Step 5—How’s My Driving? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
• Step 6—Count Your Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Section 5—Presentation Materials
• PowerPoint Presentation Script . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
• Attendance Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
• Adult Fact Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
• Child and Youth Fact Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
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Table of Contents
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• Press Release Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
• Generic Press Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
• Invitation to Presentation Flyer (in front cover)
Section 6—Resources
• Key Contact List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
• Web Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
• References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Section 7—Support Materials
• General Information
Vendors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
Healthy Beverages and Snacks Available from Maine Vendors . . . . . . . . . . . . . . . . . .60
Defining Healthy Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
How to Read a Food Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Sample Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
• School Information
Federal and State Regulations around Food Sales in Maine Schools . . . . . . . . . . . . .66
How to Calculate if Foods and Beverages Meet the “5% Rule” . . . . . . . . . . . . . . . . .68
Joint Position of the Maine Dietetic Association and the
Maine School Food Service Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
School Foods Tool Kit Document Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Section 8—Vending Machine Policy Packet 2002
• The Soda/Snack Vending Machine Policy Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . .78
• Model School Vending Machine Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
• Evaluation Study of a Snack/Soda Policy in Schools . . . . . . . . . . . . . . . . . . . . . . . . . . .85
• Soda/Snack Initiative—Partner List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
• Contacts for Further Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Sheets
• Fact
Body Weight and Sugar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Bone Health and Soda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Tooth Decay and Sugar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
• Fact Sheet References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
• Publicity for Local Soda/Snack Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
• Sample Press Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
• How to Create and Implement Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
• “Liquid Candy” Article . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
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Background Information
2
Getting “Healthy Change” from Your Change
percent of Americans consume meals and snacks away from home on any given
• Fifty-seven
day. Food away from home includes foods and beverages purchased from vending machines.
and beverages sold in vending machines do not have to meet specific standards
• Foods
for certain nutrients and may be high in calories, total fat, saturated fat, added sugars,
cholesterol, and sodium.
nutrition policies must be developed that limit the sale of less healthy food choices or
• School
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.
and employees can work together to ensure that vending machines at worksites
• Employers
include healthy snacks and beverages.
machines are found in large and small businesses, town offices, community and
• Vending
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
nutrition and increasing physical activity can prevent and control the epidemic of
• Improving
overweight and obesity, as well as decrease the risk of chronic diseases including cardiovascular
disease, diabetes, cancer, and osteoporosis.
and environmental changes for nutrition and physical activity make it easy for everyone
• Policy
to choose healthier options.
policies that support healthy options in vending machines makes healthy choices
• Developing
more widely available. Policies include written laws, regulations, and rules that have the power
to guide behavior.
interventions include changes to the economic, social, or physical environment.
• Environmental
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 49-51.
• See Section 6 for Resources, pages 54–57.
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Examples
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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.
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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 04530
Phone: (207) 442-2915
Fax: (207) 442-5260
phyllis.wolfe@biw.com
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Examples
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Casco Bay YMCA
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 04032
Phone: (207) 865-9600 ext. 27
skrouse@cumberlandcountyymca.org
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L.L.Bean
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 2001.
Implementation of the changes began in June 2001. 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.
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L.L.Bean (continued)
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
Wellness Program Director
L.L.Bean, Inc.
Health Department
Casco Street
Freeport, ME 04033
Phone: (207) 552-4538
stufts@llbean.com
Karen Knapton
Health & Counseling Consultant
L.L.Bean, Inc.
Health Department
Casco Street
Freeport, ME 04033
Phone: (207) 552-4339
kknapton@llbean.com
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Examples
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Lisbon Schools
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.
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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 04252
Phone: (207) 353-3030
jseverance@union30.org
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Examples
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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 2001. 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.
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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 2002. 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 2002.
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.
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Examples
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Maine School Administrative District #22 (continued)
KEY CONTACTS:
Rick Lyons
Superintendent
MSAD #22
24 Main Road North
Hampden, ME 04444
Phone: (207) 862-3255
rlyons@sad22.us
Chris Greenier
Food Service Director
Reeds Brook Middle School
28A Main Road North
Hampden, ME 04444
Phone: (207) 862-3543
cgreenier@sad22.us
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Examples
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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 2003.
During the 2002-2003 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, 2003.
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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 04064
Phone: (207) 934-4848
jtselikis@lms.oob.k12.me.us
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Examples
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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 2001-2002 school year. Changes were in place in the
fall of 2002.
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.
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Maine School Administrative District (MSAD) #75 (continued)
KEY CONTACT:
Mary Booth
School Health Coordinator
MSAD #75
50 Republic Avenue
Topsham, ME 04086
Phone: (207) 729-9961
Fax: (207) 725-9354
boothm@link75.org
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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 2002. 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, 2003.
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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 04694
Phone: (207) 454-7787
erickson@nbnet.nb.ca
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Action Steps
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Action Steps
Step 1—Stock Up
• Identify potential partners and designate a leader.
Step 2—Go Browsing
and identify current environments and/or
• Assess
policies related to the project.
Step 3—Dispense Ideas
clear goals and create an evaluation
• Identify
plan with measurable outcomes.
Step 4—Push the Right Buttons
key activities, locate resources (people, time,
• Outline
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.
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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.
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Identify interested partners to work on the project.
Sign-Up Sheet
___________________________________ ___________________________________ __________________________
NAME
ORGANIZATION
PHONE #
______________________________________________________________________ ________________________________________ Interested?
ADDRESS
❑ Yes ❏ No
E-MAIL
Notes: ______________________________________________________________________________________________
___________________________________ ___________________________________ __________________________
NAME
ORGANIZATION
PHONE #
______________________________________________________________________ ________________________________________ Interested?
ADDRESS
❑ Yes ❏ No
E-MAIL
Notes: ______________________________________________________________________________________________
___________________________________ ___________________________________ __________________________
NAME
ORGANIZATION
PHONE #
______________________________________________________________________ ________________________________________ Interested?
ADDRESS
❑ Yes ❏ No
E-MAIL
Notes: ______________________________________________________________________________________________
___________________________________ ___________________________________ __________________________
NAME
ORGANIZATION
PHONE #
______________________________________________________________________ ________________________________________ Interested?
ADDRESS
❑ Yes ❏ No
E-MAIL
Notes: ______________________________________________________________________________________________
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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
25
c.
b.
a.
4. Conduct a focus group discussion including people who will be affected by the change.
c.
b.
a.
3. Scan the current environment to identify potential areas for change.
c.
b.
a.
2. Meet with the decision-makers to identify current policies and resources.
c.
b.
a.
1. Identify decision-makers regarding policy and/or environmental changes.
Steps
and Tasks
Who’s
Responsible
Deliverables
Assessment Timeline Form
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
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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?
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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.
Also, check out the Centers for Disease
• Provide direction for people working on the project. Control and Prevention’s Physical Activity
Evaluation Handbook which is:
• Identify partners for collaboration.
• Quick
• Guide budget planning.
• Easy-to-read
• Retain and increase funding.
• User-friendly
• Enhance your project’s public image.
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.
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
www.cdc.gov/nccdphp/dnpa.
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.
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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.
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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.
the number achieving the chosen outcomes (e.g., number who have demonstrated
• Count
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.
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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.
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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
Possible Outcomes
Comprehensive child care
exhibit age-appropriate physical, mental, and
• Children
verbal skills.
• Children are school-ready for kindergarten.
increase knowledge about the effects of substance
• Adolescents
abuse and about substance abuse addiction.
change their attitude towards substance abuse.
• Adolescents
Graduates
remain
free of substance abuse for six months
• after program completion.
Outpatient treatment for
adolescent substance abusers
Emergency shelter beds on
winter nights
persons agree to come off the street and use the shelter.
• Homeless
Those
sheltered
• exposure to cold.do not suffer from frostbite or die from
Homework guidance by
volunteer tutors to children
enrolled in after-school program
attitudes towards schoolwork improves.
• Youths’
Youths
complete
assignments.
• Youths perform athomework
or
above
grade
level.
•
Full-day therapeutic child care
for homeless preschoolers
get respite from family stress.
• Children
Children
engage
age-appropriate play.
• Children exhibit infewer
symptoms of stress-related regression.
• Parents receive respite from
child care.
•
learn outdoor survival skills.
• Boys
Boys
develop
enhanced sense of competence.
• Boys develop and
maintain positive peer relationships.
•
have social interaction with peers.
• Participants
Participants
are
not homebound.
• Participants eat nutritious
varied diet.
• Seniors experience decreaseandin social
and health problems.
•
Overnight camping for
8–12-year-old inner-city boys
Congregate meals for
senior citizens
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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.
and percent of participants who
• Number
report that they have quit smoking by the end
•
Information and
referral program
Tutorial program for
sixth grade students
of the course.
Number and percent of participants who
have not relapsed six months after program
completion.
Callers access services to
which they are referred
or about which they are
given information.
and percent of community agencies
• Number
that report an increase in new participants
Students’ academic
performance improves.
and percent of participants who
• Number
earn better grades in the grading period
•
who came to their agency as a result of a call
to the information and referral hotline.
Number and percent of community agencies
that indicate these referrals are appropriate.
following completion of the program than in
the grading period immediately preceding
enrollment in the program.
English-as-a-secondlanguage instruction
Participants become
proficient in English.
and percent of participants who
• Number
demonstrate increase in ability to read, write,
and speak English by the end of the course.
Counseling for parents
identified as at risk for
child abuse or neglect
Risk factors decrease.
No confirmed incidents
of child abuse or neglect.
and percent of participating families
• Number
for whom Child Protective Service records
report no confirmed child abuse or neglect
during 12 months following program
completion.
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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
b) for the worse
c) stay about the same
d) I don’t have an opinion
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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.
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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.
___No
___Yes
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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!
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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.
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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) ___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
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Activities
4
Who is assigned activity?
Due Date
3) ___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
4) ___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
5) ___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
___________________________________________ ___________________ ____________
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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.
• Include a progress report from each partner at all regular meetings.
• Modify your plan as needed according to how work proceeds.
• Highlight, celebrate, and share successes along the way.
• Share ongoing accomplishments with decision-makers, supporters,
interested partners, and those affected by changes.
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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.
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Presentation Materials
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Presentation Script
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 Vending Machines.” 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.
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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.
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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.
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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 10–12
Here are several references for the information
presented here. Thank you.
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Presentation Script (continued)
Slides 10–12 (continued)
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Attendance Sheet
Date of Presentation: __________________ Location: _____________________ Time: ____________
Number of Attendees: _________________ Presenter’s Name: _________________________________
Attendees:
Name
Phone
Address
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
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Attendance Sheet
Attendees:
Name
Phone
Address
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
___________________________ ___________________ __________________________________
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Adult Fact Sheet
Foods and beverages consumed from vending machines:
percent of Americans consume meals and snacks away from home on any given
• Fifty-seven
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, 1996. Available from:
http://www.barc.usda.gov/bhnrc/foodsurvey/Eatout95.html).
than 45% of money spent on food goes to foods eaten away from the home (Clauson, A.
• More
Share of food spending for eating out reaches 47 percent. FoodReview. 1999; 22(3): 20-22).
eaten away from home are higher in fat, sodium, and calories and are lower in fiber and
• Foods
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, 1977-78 versus 1994-96: changes and consequences. Journal of
Nutrition Education and Behavior. 2002; 34: 140-150).
Obesity epidemic:
percent of Maine adults are overweight or obese (Maine Behavioral Risk Factor
• Fifty-nine
Surveillance System, 2002).
the direct costs of obesity and physical inactivity account for approximately 9.4% of
• Overall,
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): 1195-1200).
the total indirect cost of obesity was estimated to be $56 billion. Indirect costs are both
• Inthe2000,
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:
percent of Maine adults do not eat the recommended five servings of fruit and
• Seventy-one
vegetables each day (Maine Behavioral Risk Factor Surveillance System, 2002).
1989-91, the amount of soft drinks consumed by both men and women surpassed
• Between
their intake of milk (Wilkinson Enns, C.; Goldman, J.D.; and Cook, A. Trends in Food and
Nutrient Intakes by Adults: NFCS 1977-78, CSFII 1989-91, and CSFII 1994-95. Family
Economics and Nutrition Review. 1997; 10(4): 2-15).
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Child and Youth Fact Sheet
Foods and beverages consumed from vending machines:
95% of high schools, 62% of middle schools, and 26% of elementary schools had
• Nationally,
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, 2000. Journal of School Health. 2001: 71(7): 313-323).
nutrition policies must be developed that limit the sale of less healthy food choices or
• School
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): 505-514).
and beverages sold in vending machines do not have to meet specific standards for
• Foods
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): 1228-1233).
foods/beverages sold in Maine schools must meet or exceed the 5% minimal nutritional
• All
value rule (Federal Guidelines: 7 CFR Part 210 § 210.11. Competitive Food Services. August
1988. State Guidelines: Authority: 20MSRA Section 6602(5). Effective Date: August 31, 1979,
Amended February 21, 1989. 10/97 Maine Department of Education).
Obesity epidemic:
percent of Maine high school students are overweight and 15% are at risk for
• Thirteen
becoming overweight (Maine Youth Risk Behavior Survey, 2003).
percent of Maine middle school students are overweight and 18% are at risk for
• Thirteen
becoming overweight (Maine Youth Risk Behavior Survey, 2003).
percent of Maine kindergarten students are overweight and 21% are at risk for
• Fifteen
becoming overweight (Maine Child Health Survey, 2002).
the past two decades, the percentage of children who are overweight has nearly doubled
• During
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: www.cdc.gov/nchs/products/pubs/pubd/hestats/
over99fig1.html).
/over99fig1.htm].
children have an increased risk of high blood pressure, high cholesterol levels,
• Overweight
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: 518-525).
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Child and Youth Fact Sheet (continued)
the United States over the past twenty years, obesity-associated annual hospital costs for
• Inyouth
aged 6 to 17 years have increased more than threefold, from $35 million in 1979-1981
to $127 million in 1997-1999 (Wang, G.; Dietz, W. Economic burden of obesity in youths
aged 6 to 17 years: 1979-1999. Pediatrics 2002 May; 109(5): e81. Available from:
http://www.pediatrics.org/cgi/content/full/109/5/e81).
Eating behaviors:
with the highest consumption of total sweetened beverages consume more calories
• Children
(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): 1475-1478).
percent of Maine high school students do not eat the recommended five
• Seventy-seven
servings of fruit and vegetables each day (Maine Youth Risk Behavior Survey, 2003).
who drink soft drinks consume more total calories than those who do not consume
• Children
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): 436-441).
percent of Maine high school students do not consume the recommended
• Seventy-eight
servings of milk each day (Maine Youth Risk Behavior Survey, 2003).
play a critical role in producing healthy students who are better able to develop
• Schools
and learn by establishing an environment that supports a nutritious diet (U.S. Department
of Health and Human Services. Healthy People 2010. Second ed. Washington, D.C.: U.S.
Government Printing Office. November 2000).
12 oz. can of a carbonated non-diet soft drink contains approximately 10 teaspoons of
• Each
sugar (Larson Duyff, R. American Dietetic Association Complete Food and Nutrition Guide,
Second Edition. Hoboken, NJ: John Wiley & Sons, Inc., page 169, 2002).
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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.
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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 #).
###
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Key Contact List
Jennifer Willey, Nutrition Consultant
Canteen Service Company
252 Old Lisbon Road, Lewiston, ME 04240
1-800-499-0851 • E-mail: lewiston@canteenmaine.com • Web site: www.canteenmaine.org
· 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 04330
207-629-9272 • Fax: (207) 629-9277 • E-mail: korourke@mcph.org • Web site: www.mcph.org
· 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 04444
207-862-3543 • E-mail: cgreenier@sad22.us
· 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 04901
207-873-4281• Fax: (207) 873-5331• E-mail: scaruso@fc.wtvl.k12.me.us
· 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.
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Web Resources
Information Resources
Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity
www.cdc.gov/nccdphp/dnpa
• 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
http://www.fns.usda.gov/fncs/
• 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
www.5aday.com
• 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
www.cspinet.org/nutritionpolicy
• 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 www.cspinet.org/schoolfoods. 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
http://ctb.lsi.ukans.edu/tools/tools.htm
• 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
www.californiaprojectlean.org/consumer/
• 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.
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Web Resources (continued)
Action for Healthy Kids
www.actionforhealthykids.org/
• 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
www.healthinschools.org/parents/lunch.htm
• 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
www.drinkmainemilk.com
• 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
www.actionforhealthykids.org/docs/profiles/maine.pdf
• Contains information about demographics, health, fitness, current legislation, and policies
in Maine.
Maine Cardiovascular Health Program
www.healthymainepartnerships.com/mcvhp2.html
• 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
www.maine-nutrition.org
• 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.
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References
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, 1996. Available from: http://www.barc.usda.gov/bhnrc/foodsurvey/Eatout95.html.
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):505-514.
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 2000. Journal
of School Health. 2001; 71(7):313-323.
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Support Materials
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Vendors
These vendors participated in a vending survey to identify healthy snacks and beverages.
All Seasons Services
245 Rodman Road
Auburn, ME 04210-1048
Contact: Thomas Lerette
Phone: (800) 244-8115
(207) 783-3279 x104
Fax: (207) 782-7284
tlerette@allseasonsservices.com
Web: www.allseasonsservices.com
Region: Southern Maine and parts
of Mid-Maine
Athearn Vending Company
489 Appleton Road
Union, ME 04862
Contact: Aaron Athearn
Phone: (800) 649-1931
(207) 785-2800
Region: Bangor/Palmyra to Portland and
Farmington to Blue Hill
Automatic Vending & Games
167 Target Industrial Circle
Bangor, ME 04401
Contact: Carolyn Smith
Phone: (207) 945-0027
Fax: (207) 942-7757
Canteen Service Company
89 Industrial Park Road
Saco, ME 04072
244 Perry Road
Bangor, ME 04401
Contact: Jennifer Willey
Phone: (800) 499-0851
Fax: (207) 783-7143
lewiston@canteenmaine.com
Web: www.canteenmaine.com
Region: Every county in Maine with the
exception of Aroostook
Coca-Cola Bangor
91 Dowd Road
Bangor, ME 04401
Contact: Ron Tibbetts
Phone: (207) 942-5546
Fax: (207) 941-8053
Region: Eastport to Greenville and Thomaston
to Millinocket
Coca-Cola Presque Isle
1005 Airport Road
Presque Isle, ME 04795
Contact: Alton Hartt
Phone: (207) 764-4481
Fax: (207) 764-0346
Region: Aroostook County, Danforth
and Patten
Coca-Cola Southern Maine
316 Western Avenue
South Portland, ME 04106
Contact: Tony Phillips
Phone: (800) 339-2653
Fax: (207) 773-2462
Region: From Kittery to Waterville
252 Old Lisbon Road
Lewiston, ME 04240
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Vendors (continued)
Fred’s Vending Service
RR 1, Box 1340
Oakland, ME 04963
Contact: Paul Rodrigue
Phone: (207) 872-5824
Fax: (207) 873-2464
Region: Portland to Bangor and Farmington
to Belfast
Hedrich Vending
15 Industrial Street
Presque Isle, ME 04769
Contact: Todd Hedrich
Phone: (207) 764-3747
Fax: (207) 764-0003
Region: All of Aroostook County and parts of
Washington County
J & M Vending
67 Jarvis Gore Drive
Eddington, ME 04428
Contact: Mark/Jeanine Proulx
Phone: (207) 843-5451
Region: Bangor area, Hampden, Lincoln,
Ellsworth
L & L Vending
28 Ryder Bluff Road
Holden, ME 04429
Contact: Scott Proulx
Phone: (877) 989-4388
Region: Bangor area, Old Town, Route 1A to
Bar Harbor, and outskirts
Michaud Distributors
5 Lincoln Avenue
Scarborough, ME 04074
Contact: Greg Haskell
Phone: (207) 885-9473
Fax: (207) 883-0704
Region: Southern Maine
New England Vending
1 Lisbon Road
Lisbon, ME 04250
Phone: (207) 786-0721
Fax: (207) 786-2549
Region: Bangor to York
Pine State Vending
8 Ellis Avenue
Augusta, ME 04330
Contact: Larry Auger
Phone: (207) 622-3741
Fax: (207) 621-4029
Region: Bethel to York, Rockland, Camden,
Bangor, Waterville, Lewiston, Portland
Seltzer & Rydholm
191 Merrow Road
P.O. Box 1090
Auburn, ME 04211
Contact: Marcus Day
Phone: (207) 784-5791
Fax: (207) 784-8685
Region: The following counties: Sagadahoc,
Somerset, York, Androscoggin, Cumberland,
Franklin, Kennebec, Knox, Lincoln, Oxford,
half of Waldo
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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
Fresh Fruit
(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.)
Dole
Apple
Grape
Orange
Minute Maid
Apple
Orange
Orange with Calcium
(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.)
Tropicana
Grape
Ruby Red
(16 oz.)
(16 oz.)
Very Fine
Grape
Grapefruit
Orange
(10 oz. and 12 oz.)
(10 oz. and 12 oz.)
(12 oz. and 16 oz.)
Oakhurst
Orange Juice
(16 oz.)
100% Vegetable Juice
Campbell’s
Tomato
V-8
(5.5 oz. and 11.5 oz.)
(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.)
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
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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
Fat1 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 http://www.cdc.gov/mmwr/preview/mmwrhtml/00042446.htm.
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Defining Healthy Food
U.S. Food and Drug Administration (FDA)
Nutrition Labeling and Education Act of 1990 (NLEA)
http://vm.cfsan.fda.gov
• 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
http://www.aha.org
• 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.
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Defining Healthy Food (continued)
U.S. Department of Agriculture Food and Nutrition Services
http://www.fns.usda.gov
• 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.
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How to Read a Food Label
Nutrition Facts
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.
Pretzels
Serving Size 1 oz. (28 g)
This tells you the total calories
for the serving size listed.
Amount Per Serving
Calories 108
Recommended daily total
fat is less than 65 g or 30%
of calories.
This shows how many of the
total calories come from fat.
Calories from Fat 9
This helps you see how a
food fits into your overall
daily diet.
% Daily Value*
Total Fat 1 g
Recommended daily total of
sodium is less than 2,400 mg.
2%
Sodium 486 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.
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.
{
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.
20%
Total Carbohydrate 23 g
8%
Dietary Fiber 1 g
4%
Protein 3 g
6%
Iron
7%
Thiamin
9%
Riboflavin
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.
10%
Niacin
This means that there are
not enough of these in this
snack to measure.
7%
Not a significant source of saturated fat, cholesterol,
vitamin A, vitamin C, and calcium. Values are not
available for sugars.
This tells you that % Daily
Values are based on a 2,000
calorie diet.
*Percent 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.
You still have 80% of your
Daily Value left for the rest
of the day.
100% total Daily Value
Example: If you want to limit a nutrient, like fat, saturated fat,
cholesterol, or sodium, choose foods with a lower % Daily Value.
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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
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Federal and State Regulations Around Food Sales in Maine Schools
I. Federal Regulations: 7CFR 210 March 1988
210.11 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, 1994.
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.
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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
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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 2.00.
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 = 2.00
5% 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.
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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 = 2.15
5% per
100 calories
X2.15
X2.15
10.75%
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.
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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
100 calories
or
Compare by Percentage
X
100 calories
138 calories
5.9 mg
138 calories
8%
100 x 5.9 =
138 x X
100 x 8 =
138 x X
590
X
800 =
=
=
138
=
=
X
X
138
4.27 mg
5.8%
138 590
4.27 mg is more than 3 mg
(5% or RDI) for 100 calories.
138 800
and
5.8 is greater than 5%
for 100 calories.
Adapted from Maine Department of Education, Child Nutrition Services “Does Your A La
Carte Product Make the Grade?”
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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.
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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.
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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.
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Joint Position (continued)
APPENDIX #1
Specific Recommendations for Foods Allowed in Schools
Category
Foods Not Allowed
Foods Allowed
Beverages
Soft drinks, sports drinks,
fruit punch, iced tea, other
beverages containing caffeine
(except chocolate milk) or added
sugar, juices containing less than
50% real juice.
Low fat and nonfat milk, soy milk,
rice milk, and chocolate milk;
juices containing > 50% real
juice; bottled water or seltzer;
other beverages without added
sweeteners (natural or artificial).
Entrees/Side Dishes
Excessive portions* More than 30%
of total calories from fat (excluding
fat from nuts, seeds, peanut butter).
More than 10% of calories from
saturated fat. More than 35% by
weight of sugar (excluding sugars
occurring naturally in fruit and
dairy products).
Appropriate portions*
All fruits, vegetables, legumes/soy
products, lean animal protein
foods, nuts, seeds, peanut
butter, low or nonfat dairy products.
Desserts/Snack
Foods/Grain Foods
Excessive portions* More than 30%
of total calories from fat (excluding
fat from nuts, seeds, peanut butter).
More than 10% of calories from
saturated fat. More than 35% by
weight of sugar (excluding sugars
found naturally in fruit and dairy
products).
Appropriate portions*
Lower-fat grain foods (preferably
whole grain with at least 2 grams
fiber) such as some popcorn,
some chips, some granola bars,
some crackers, pretzels, low fat/
low-sugar baked goods, low-sugar
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).
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Joint Position (continued)
APPENDIX #2
Recommended Portion Limits
Item
Maximum Portion
Entrees
Consistent with National School Lunch Program
Beverages (water not limited)
12 oz.
Yogurt (not frozen)
8 oz.
Frozen Desserts/Ice Cream
3 fl. oz.
Bakery Items (such as pastries, muffins, etc.)
3 oz.
Cookies/Cereal Bars
2 oz.
Snacks/Sweets
Such as chips, crackers, popcorn, cereal,
trail mix, nuts, seeds, dried fruit, jerky, etc.
1.25 oz.
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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: 108-111.
(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: 505-514.
(www.eatright.org/Public/GovernmentAffairs/92_8243.cfm)
Policy Statement—American Academy of Pediatrics, Prevention of Pediatric Overweight and
Obesity. Pediatrics. 2003; 112(2): 424-430.
(http://aap.org/policy/s100029.html)
California Center for Public Health Advocacy—National Consensus Panel on School Nutrition:
Recommendations for Competitive Food Standards in California Schools. March 2002.
(www.publichealthadvocacy.org/school_food_standards/school_food_standards.html)
Resolution #10 (2002)—Maine Medical Association—Curtailing Childhood Obesity.
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School Foods Tool Kit Document Summary
Suggested Citation:
Center for Science in the Public Interest. School Foods Tool Kit. Washington, D.C.
September 2003.
Downloadable Version:
www.cspinet.org/schoolfoods
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 20009
(202) 777-8352
Cost: Hard copies are $10.00.
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 40-41 list many healthy snacks and beverage options for school
vending machines. Pages 44-45 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.
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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.
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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.
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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.
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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
2000. 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.
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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)
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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.
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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.
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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
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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.
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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
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Contacts For Further Information :
Lori Kaley
Maine Nutrition Network
295 Water Street
Augusta, ME 04330
Phone: 626-5258
lori.kaley@maine.gov
Mary Moody
Maine Department of Education
32 State House Station
Augusta, ME 04333
Phone: 624-6876
mary.moody@maine.gov
Karen O’Rourke
Maine Center for Public Health
12 Church Street
Augusta, ME 04330
Phone: 629-9272
korourke@mcph.org
Kristine Perkins
Bureau of Health / Oral Health Program
11 State House Station
Key Plaza
4th Floor
Augusta, ME 04333
Phone: 287-3263
kristine.perkins@maine.gov
Amy Root
Maine Nutrition Network
295 Water Street
Augusta, ME 04330
Phone: 626-5200
amy.root@maine.gov
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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 www.cdc.gov/nccdphp/dnpa/bmi/
•
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.
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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%.
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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.
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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 1996. Archives of Diseases/Children, 83, 18–24.
“Embrace Your Health! Lose Weight If You Are Overweight,” NHLBI and Office of Research on
Minority NIH Publication No. 97-4061, Sept. 1997.
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, 505-508.
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, 2000.
Gift, H.C., 1997. Oral Health Outcomes Research: Challenges and Opportunities. In Slade G.D.,
ed., Measuring Oral Health and Quality of Life pp. 25-46. Chapel Hill NC: Department of
Dental Ecology, University of North Carolina.
Office of Disease Prevention and Health Promotion. 2000. Healthy People 2010. Cited January
15, 2001; available at: http://www.health.gov/healthypeople/Document/HTML/Volume
2/21Oral.html-Toc489700403.
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-2000. October 2001.
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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 e-mails announcing local
community events.
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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 e-mail 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.
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Sample Press Release—modify as needed
FOR IMMEDIATE RELEASE
(Date)
FOR INFORMATION CONTACT:
(Your Spokesperson’s name)
(Phone number)
Shed Some Light on Soda and Snacks
(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 12-19 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!
###
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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.
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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.
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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 2000
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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 60 12-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
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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 576 12-ounce servings per year or 1.6 12-ounce cans per day for every man,
woman, and child.4 That is also more than twice the amount produced in 1974. Artificially
sweetened diet sodas account for 24% of sales, up from 8.6% in 1970.5
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
1977-78
7
6
3
4
1987-88
12
7
6
5
1994-96
19
12
9
8
Calculated from U.S. Department of Agriculture Nationwide Food Consumption Survey, 1977-78; Continuing Survey of Food Intakes by
Individual, 1987-88, 1994-96.
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
1977-78
16
15
1987-88
23
18
1994-96
28
21
U.S. Department of Agriculture Nationwide Food Consumption Survey, 1977-78; Continuing Survey of Food Intakes by Individual, 1987-88,
1994-96.
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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 1977-78.
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 21⁄2 12-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
5
25
50
75
90
95
1994-96;
boys, 13-18
6
12
20
30
44
57
1994-96;
girls, 13-18
4
6
14
23
32
40
1977-78;
boys and girls
3
5
9
15
-
27
Percentile calculations by Environ, Inc.; data from USDA, CSFII, Figures for 1977-78 calculated from P.M. Guenther, Journal of the American
Dietetic Association 1986;86:493-9.
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
2 1⁄4 cans. That’s slightly more than one-half of current consumption.
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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.
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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 1 1⁄2 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 1977-78. (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.
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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 1994-96, 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 1 1⁄4 cups of fluid milk. Girls consumed about 1 1⁄2 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 1977-78, 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 1994-96, 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
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Liquid Candy—How Soft Drinks Are Harming Americans’ Health (continued)
Health Impact of Soft Drinks
The soft drink industry has consistently portrayed its products as being positively healthful,
saying they are 90% water and contain sugars found in nature. A poster that the National Soft
Drink Association has provided to teachers states:
As refreshing sources of needed liquids and energy, soft drinks represent a positive addition to a
well-balanced diet. These same three sugars also occur naturally, for example, in fruits. In your
body, it makes no difference whether the sugar is from a soft drink or a peach.23
M. Douglas Ivester, Coca-Cola’s chairman and CEO, defending marketing in Africa, said,
“Actually, our product is quite healthy. Fluid replenishment is a key to health....Coca-Cola does
a great service because it encourages people to take in more and more liquids.”24
In fact, soft drinks pose health risks both because of what they contain (for example, sugar and
various additives) and what they replace in the diet (beverages and foods that provide vitamins,
minerals, and other nutrients).
Obesity
Obesity increases the risk of diabetes and cardiovascular disease and causes severe social and
psychological problems in millions of Americans. Between 1971-74 and 1988-94, obesity rates
in teenage boys soared from 5% to 12% and in teenage girls from 7% to 11%. Among adults,
between 1976-80 and 1988-94, the rate of obesity jumped by one-third, from 25% to 35%.25
Numerous factors—from lack of exercise to eating too many calories to genetics—contribute to
obesity. Soda pop adds unnecessary, nonnutritious calories to the diet, though it has not been
possible to prove that it (or any other individual food) is responsible for the excess calories that
lead to obesity. However, one recent study found that soft drinks provide more calories to overweight youths than to other youths. The difference was most striking among teenage boys: Soda
pop provides 10.3% of the calories consumed by overweight boys, but only 7.6% of calories
consumed by other boys. There was no consistent pattern of differences with regard to intake of
calories, fat, or several other factors.26
Obesity rates have risen in tandem with soft drink consumption and heavy consumers of soda
pop have higher calorie intakes.27 While those observations do not prove that sugary soft
drinks cause obesity (heavy consumers may exercise more and need more calories), heavy
consumption is likely to contribute to weight gain in many consumers.
Regardless of whether soda pop (or sugar) contributes to weight gain, nutritionists and weight
loss experts routinely advise overweight individuals to consume fewer calories—starting with
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Liquid Candy—How Soft Drinks Are Harming Americans’ Health (continued)
empty-calorie foods such as soft drinks. 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.28
Bones and Osteoporosis
People who drink soft drinks instead of milk or other dairy products likely will have lower calcium
intakes. Low calcium intake contributes to osteoporosis, a disease leading to fragile and broken
bones.29 Currently, 10 million Americans have osteoporosis. Another 18 million have low bone
mass and are at increased risk of osteoporosis. Women are more frequently affected than men.
Considering the low calcium intake of today’s teenage girls, osteoporosis rates may well rise.
The risk of osteoporosis depends in part on how much bone mass is built early in life. Girls
build 92% of their bone mass by age 18,30 but if they don’t consume enough calcium in their
teenage years they cannot “catch up” later. That is why experts recommend higher calcium
intakes for youths 9 to 18 than for adults 19 to 50. Currently, teenage girls are consuming only
60% of the recommended amount, with soft drink drinkers consuming almost one-fifth less
than nonconsumers.31
While osteoporosis takes decades to develop, preliminary research suggests that drinking soda
pop instead of milk can contribute to broken bones in children. One study found that children
3 to 15 years old who had suffered broken bones had lower bone density, which can result from
low calcium intake.32
Tooth Decay
Refined sugar is one of several important factors that promote tooth decay (dental caries).
Regular soft drinks promote decay because they bathe the teeth of frequent consumers in sugar
water for long periods of time during the day. An analysis of data from 1971-74 found a strong
correlation between the frequency of between-meal consumption of soda pop and dental caries.33
(Those researchers considered other sugary foods in the diet and other variables.) Soft drinks
appear to cause decay in certain surfaces of certain teeth more than in others.34
Tooth decay rates have declined considerably in recent decades, thanks to such preventive factors
as fluoride-containing toothpaste, fluoridated water, tooth sealants, and others. Nevertheless,
caries remains a problem for some people. A large survey in California found that children (ages
6 to 8) of less-educated parents have 20% higher rates of decayed and filled teeth.35 A national
study found that African-American and Mexican-American children (6 to 18 years old) are
about twice as likely to have untreated caries as their white counterparts.36 For people in highrisk groups, prevention is particularly important.
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Liquid Candy—How Soft Drinks Are Harming Americans’ Health (continued)
To prevent tooth decay, even the Canadian Soft Drink Association recommends limiting
between-meal snacking of sugary and starchy foods, avoiding prolonged sugar levels in the
mouth, and eating sugary foods and beverages with meals. Unfortunately, many heavy drinkers
of soft drinks violate each of those precepts.
Heart Disease
Heart disease is the nation’s number-one killer. Some of the most important causes are diets
high in saturated and trans fat and cholesterol, cigarette smoking, and a sedentary lifestyle. In
addition, in many adults a diet high in sugar may also promote heart disease.
High-sugar diets may contribute to heart disease in people who are “insulin resistant.” Those
people, an estimated one-fourth of adults, frequently have high levels of triglycerides and low
levels of HDL (“good”) cholesterol in their blood. When they eat a diet high in carbohydrates,
their triglyceride and insulin levels rise. Sugar has a greater effect than other carbohydrates.37
The high triglyceride levels are associated with a higher risk of heart disease.38 It would make
sense for insulin-resistant people, in particular, to consume low levels of regular soft drinks and
other sugary foods. Research is needed on insulin resistance in adolescents.
Kidney Stones
Kidney (urinary) stones are one of the most painful disorders to afflict humans and one of the
most common disorders of the urinary tract. According to the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK), a unit of the National Institutes of Health, more
than one million cases of kidney stones were diagnosed in 1985.39 NIDDK estimates that 10% of
all Americans will have a kidney stone during their lifetime. Several times more men, frequently
between the ages of 20 and 40, are affected than women. Young men are also the heaviest
consumers of soft drinks.
After a study suggested a link between soft drinks and kidney stones, researchers conducted an
intervention trial.40 That trial involved 1,009 men who had suffered kidney stones and drank at
least five 1/3 ounces of soda pop per day. Half the men were asked to refrain from drinking pop,
while the others were not asked. Over the next three years, drinkers of Coca-Cola and other cola
beverages acidified only with phosphoric acid who reduced their consumption (to less than half
their customary levels) were almost one-third less likely to experience recurrence of stones.
Among those who usually drank soft drinks acidified with citric acid (with or without phosphoric
acid), drinking less had no effect. While more research needs to be done on the cola-stone
connection, the NIDDK includes cola beverages on a list of foods that doctors may advise
patients to avoid.
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Additives: Psychoactive Drug, Allergens, and More
Several additives in soft drinks raise health concerns. Caffeine, a mildly addictive stimulant
drug, is present in most cola and “pepper” drinks, as well as some orange sodas and other products.
Caffeine’s addictiveness may be one reason why six of the seven most popular soft drinks
contain caffeine.41 Caffeine-free colas are available, but account for only about 5% of colas made
by Coca-Cola and Pepsi-Cola.42 On the other hand, Coca-Cola and other companies have begun
marketing soft drinks, such as Surge, Josta, and Jolt, with 30% to 60% more caffeine than Coke
and Pepsi.
In 1994-96, the average 13- to 18-year-old boy who drank soft drinks consumed about 1 2/3
cans per day. Those drinking Mountain Dew would have ingested 92 mg of caffeine from that
source (55 mg caffeine/12 ounces). That is equivalent to about one six-ounce cup of brewed
coffee. Boys in the 90th-percentile of soft drink consumption consume as much caffeine as is in
two cups of coffee; for girls the figure is 1 1⁄2 cups of coffee.
One problem with caffeine is that it increases the excretion of calcium in urine.43 Drinking 12
ounces of caffeine-containing soft drink causes the loss of about 20 milligrams of calcium, or
two percent of the U.S. RDA (or Daily Value). That loss, compounded by the relatively low calcium
intake in girls who are heavy consumers of soda pop, may increase the risk of osteoporosis.
Caffeine can cause nervousness, irritability, sleeplessness, and rapid heart beat.44 Caffeine causes
children who normally do not consume much caffeine to be restless and fidgety, develop
headaches, and have difficulty going to sleep.45 Also, caffeine’s addictiveness may keep people
hooked on soft drinks (or other caffeine-containing beverages). One reflection of the drug’s
addictiveness is that when children ages six to 12 stop consuming caffeine, they suffer
withdrawal symptoms that impair their attention span and performance.46
Several additives used in soft drinks cause occasional allergic reactions. Yellow 5 dye causes asthma,
hives, and a runny nose.47 A natural red coloring, cochineal (and its close relative carmine),
causes life-threatening reactions.48 Dyes can cause hyperactivity in sensitive children.49
In diet sodas, artificial sweeteners may raise concerns. Saccharin, which has been replaced by
aspartame in all but a few brands, has been linked in human studies to urinary bladder cancer
and in animal studies to cancers of the bladder and other organs.50 Congress has required products
made with saccharin to bear a warning label. The safety of acesulfame-K, which was approved
in 1998 for use in soft drinks, has been questioned by several cancer experts.51 Also, aspartame
should be better tested.
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Aggressive Marketing of Soft Drinks
Soft drink companies are among the most aggressive marketers in the world. They have used
advertising and many other techniques to increase sales.
Soft drink advertising budgets dwarf all advertising and public service campaigns promoting
the consumption of fruits, vegetables, healthful diets, and low fat milk. In 1997, Coca-Cola,
which accounts for 44%52 of the soft drink market in the U.S., spent $277 million on advertising
and the four major companies spent $631 million. Between 1986 and 1997 those companies spent
$6.8 billion on advertising.53
Companies make sure their products are always readily accessible. Thus, in 1997, 2.8 million
soft drink vending machines dispensed 27 billion drinks worth $17.5 billion.54 Coca-Cola’s soft
drinks are sold at two million stores, more than 450,000 restaurants, and in 1.4 million vending
machines and coolers.55
Table 4. Beverage prices
Beverage
Cost
Cost per quart (¢)
Cola (supermarket brand)
$.59/2 liters
28
Coca-Cola
$.69/2 liters
33
Pepsi-Cola
$.99/6 12-oz. cans
$3.99/24 12-oz. cans
44
Bottled water (supermarket brand)
$.79/gallon
20
Bottled spring water (supermarket brand)
$.89/gallon
22
Seltzer water, club soda (supermarket brand)
$.89/2 liters
42
Milk
$2.79/gallon
$.95/quart
70
95
Orange juice, frozen (supermarket brand)
$1.39/12-oz. can
93
Prices at Washington-area supermarkets, September, 1998.
The major companies target children aggressively (though, to their credit, they have not gone
after 4-year-olds by advertising on Saturday morning television). Pepsi advertises on Channel
One, a daily news program shown in 12,000 schools.56 Companies inculcate brand loyalties in
children and boost consumption by paying school districts and others for exclusive marketing
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agreements. For instance, Dr. Pepper paid the Grapevine-Colleyville, Texas, School District
$3.45 million for a ten-year contract (it includes rooftop advertising to reach passengers in
planes landing at the nearby Dallas/Ft. Worth Airport).57 To reach youths after school, Coca-Cola
is paying $60 million over ten years to the Boys & Girls Clubs of America for exclusive marketing rights in more than 2,000 clubs.58
In one of the most despicable marketing gambits, Pepsi, Dr. Pepper, and Seven-Up encourage
feeding soft drinks to babies by licensing their logos to a major maker of baby bottles,
Munchkin Bottling, Inc. Infants and toddlers are four times likelier to be fed soda pop out of
those bottles than out of regular baby bottles.59
Also fueling soft drink sales is the low cost of the sugar water-additive products. (See Table 4)
Supermarket brands are particularly cheap, easily getting as low as 28 cents per quart, but even
Coca-Cola and Pepsi-Cola are available for 33 cents per quart when on special. Milk costs two
to three times as much, about 70 to 95 cents per quart.
Moreover, in recent years, inflation has had a greater effect on the price of milk than of soft
drinks. Between 1982-84 and 1997 the Consumer Price Index rose 2.3 times as much for milk
as for soft drinks.60
The soft drink industry is aiming for continued expansion in coming years. Thus, the president
of Coca-Cola bemoans the fact that his company accounts for only 1 billion out of the 47 billion
servings of all beverages that earthlings consume daily.61 The company’s goal is to: make Coca-Cola
the preferred drink for any occasion, whether it’s a simple family supper or a formal state dinner.
To build pervasiveness of our products, we’re putting ice-cold Coca-Cola classic and our other
brands within reach, wherever you look: at the supermarket, the video store, the soccer field,
the gas station—everywhere.62
Recommendations for Action
In part because of powerful advertising, universal availability, and low price, and in part because
of disinterest on the part of many nutritionists and other health professionals, Americans have
come to consider soft drinks a routine snack and a standard, appropriate part of meals instead
of an occasional treat, as they were treated several decades ago. Moreover, many of today’s
younger parents grew up with soft drinks, see their routine consumption as normal, and so
make little effort to restrict their children’s consumption of them.
It is a fact, though, that soft drinks provide enormous amounts of sugar and calories to a nation
that does not meet national dietary goals and that is experiencing an epidemic of obesity. The
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replacement of milk by soft drinks in teenage girls’ diets portends continuing high rates of
osteoporosis. Soft drinks may also contribute to dental problems, kidney stones, and heart
disease. Additives may cause insomnia, behavioral problems, and allergic reactions and may
increase slightly the risk of cancer.
The industry promises that it will be doing everything possible to persuade even more
Americans to drink even more soda pop even more often. Parents and health officials need to
recognize soft drinks for what they are—liquid candy—and do everything possible to return
those beverages to their former, reasonable role as an occasional treat.
•
Individuals and families should consider how much soda pop they are drinking and reduce
consumption accordingly. Parents should stock their homes with healthful foods and
beverages that family members enjoy.
•
Physicians, nurses, and nutritionists routinely should ask their patients how much soda pop
they are drinking and advise them, if appropriate, of dietary changes to make.
•
Organizations concerned about women’s and children’s health, dental and bone health, and
heart disease should collaborate on campaigns to reduce soft drink consumption.
•
Local, State, and Federal governments should be as aggressive in providing water fountains
in public buildings and spaces as the industry is in placing vending machines everywhere.
•
State and local governments should considering taxing soft drinks, as Arkansas, Tennessee,
Washington, and West Virginia already do. Arkansas raised $40 million in fiscal year 1998
from that tax.63 If all states taxed soft drinks at Arkansas’ rate (2 cents per 12-ounce can),
they could raise $3 billion annually. Those revenues could fund campaigns to improve diets,
build exercise facilities (bike paths, swimming pools, etc.), and support physical education
programs in schools.
•
Local governments could require calorie listings on menu boards at fast-food outlets and on
vending machines to sensitize consumers to the nutritional “cost” of sugared soft drinks and
other foods.
•
School systems and other organizations catering to children should stop selling soft drinks,
candy, and similar foods in hallways, shops, and cafeterias.
•
School systems and youth organizations should not auction themselves off to the highest
bidder for exclusive soft drink marketing rights. Those deals profit the companies and
schools at the expense of the students’ health.
•
The National Academy of Sciences or the Surgeon General should review the impact of
current and projected levels of soft drink (and sugar) consumption on public health.
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•
Soft drink companies voluntarily should not advertise to children and adolescents. Labels
should advise parents that soft drinks may replace low fat milk, fruit juice, and other healthy
foods in the diets of children and adolescents.
•
Scientific research should explore the role of heavy consumption of soft drinks (and sugar)
in nutritional status, obesity, caries, kidney stones, osteoporosis, and heart disease.
Endnotes
1. JAMA. 1942;120:763-5.
2. This review does not cover sweetened non-carbonated beverages (bottled ice teas, fruit drinks and ades, bottled ice tea, etc.).
3. National Soft Drink Assoc. Web site, www.nsda.org.
4. Ibid.
5. USDA/ERS: Food Consumption, Prices, and Expenditures, 1970-95, Stat. Bull. No. 939 (August, 1997).
6. Unless otherwise specified, all data on consumption of soft drinks, milk, and calorie intake were obtained or calculated from U.S.
Department of Agriculture (USDA) surveys (one-day data) particularly Continuing Survey of Food Intakes of Individuals (CSFII), 199496 (Data Tables 9.4, 9.7, 10.4, 10.7); 1987-88 (Report No. 87+1, Tables 1.2-1 and -2; 1.7-1 and -2); Nationwide Food Consumption
Surveys, 1977-78 (Tables A1.2-1 and -2; A1.7-1 and -2). Intake of added sugars by age was obtained from USDA’s analysis for purposes of
the Food Guide Pyramid (two-day 1996 data, Table 6). Teens’ consumption of vegetables, fruit, and other foods also is from Pyramid
Servings Data, USDA, Dec. 1997, based on CSFII, 1996. We are grateful to USDA staff members in the Food Surveys Research Group for
their assistance. (See USDA Web site: www.barc.usda.gov/bhnrc/foodsurvey/home.htm)
7. Analyses by Environ, Inc., Sept. 1998, based on USDA CSFII 1994-96 two-day data.
8. Ibid.
9. CSPI survey, August 26, 1998.
10. Nutrition Action Healthletter. 1998 (July/Aug.);25(6):6.
11. Am. J. Clin. Nutr. 1995;62(suppl):178S-94S.
12. Those dietary surveys find that consumers report consuming only 57% of all soft drinks produced. While some soft drinks are wasted
or returned to manufacturers, that fact provides good evidence that the surveys greatly underestimate actual intake.
13. U.S. Dept. Agr. The Food Guide Pyramid. Home and Garden Bulletin No. 252, Oct. 1996, p. 17.
14. USDA’s recommendation applies to diets that include 30% of calories from fat. Because 33% of the calories teens consume come from
fat, there is even less room in the diet for added sugar.
15. J. Am. Diet Assoc. 1998;98:537-547.
16. USDA CSFII 1994-96.
17. Diet sodas, which provide no calories, constitute only 4% of soft drink consumption by teenage boys and 11% by teenage girls.
18. Pediatrics. 1997;100:323-9. Pediatrics. 1998;101:952-3.
19. USDA, Center for Nutrition Policy and Promotion, CNPP-5; The Healthy Eating Index, 1994-96, July 1998.
20. Personal communication, Lisa Harnack, Sept. 22, 1998.
21. Journal of the American Dietetic Association 1986;86:493-9.
22. Analyses by Environ, Inc., see note 7. Calcium was the only micronutrient examined.
23. National Soft Drink Assoc. “Soft Drinks and Nutrition.” Washington, D.C. (undated).
24. New York Times. May 26, 1998, p.D1.
25. Arch. Pediatr. Adolesc. Med. 1995; 149:1085-91. Morbidity Mortality Weekly Report. March 7, 1997;46(9):199-201.
26. Troiano RP, et al. “Energy and fat intake of children and adolescents in the United States. Data from the National Health and Nutrition
Examination Surveys.” Am. J. Clin. Nutr. In press.
27. Analyses by Environ, see note 7.
28. “Embrace Your Health! Lose Weight if You Are Overweight” NHLBI and Office of Research on Minority Health, NIH Publication No.
97-4061, Sept. 1997.
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29. National Osteoporosis Foundation. “Fast facts on osteoporosis.” Web site, www.nof.org/stats.html.
30. Institute of Medicine. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. 1997; pp.4-28.
31. Analyses by Environ, see note 7.
32. J. Bone Miner. Res. 1998;13:143-8.
33. J. Am. Dent. Assoc. 1984;109:241-5.
34. J. Am. Dent. Assoc. 1972;85:81-89.
35. The Dental Health Foundation. “A Neglected Epidemic: The Oral Health of California’s Children.” (San Rafael, 1997).
36. J. Am. Dent. Assoc. 1998;129:1229-1238.
37. Am. J. Clin. Nutr. 58(Suppl); 1993:800S. J. Clin. Endocrin. Metab. 1984;59:636.
38. J. Am. Med. Assoc. 1996;276:882-8.
39. National Institute of Diabetes and Digestive and Kidney Diseases, web site, http://www.niddk.nih.gov/
40. J. Clin. Epidemiol. 1992 (Aug);45(8):911-916.
41. Beverage Digest Web site, www.beverage-digest.com/980212.html.
42. Ibid.
43. Osteoporosis Intern. 1995;5:97-102.
44. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (Washington, D.C.), 4th ed. 1994.
45. J. Nervous Mental Disease 1981;169:726. Arch. Gen. Psychiat. 1984;41:1073.
46. J. Am. Acad. Child Adolesc. Psychiatry. 1998;37:858-65.
47. Federal Register. 1979;44:37212-37221.
48. Ann. Allergy Asthma Immunol. 1997;79:415-9.
49. Science. 1980;207:1487.
50. Lancet 1980;i:837-840. Env. Health Perspectives 1998;25:173-200.
51. Associated Press. “Consumer group attacks artificial sweetener.” Aug. 1, 1996.
52. Beverage World Web site, www.beverageworld.com.
53. Beverage Digest Web site (data expressed in 1998 dollars).
54. Vending Times, 1998;38(9):15,21,22.
55. Wall Street Journal, May 8, 1997, p.1.
56. Wall Street Journal, Sept. 15, 1997, B1.
57. Selling to Kids, August 19, 1998, p. 4.
58. Chronicle of Philanthropy. July 30, 1998, p.25.
59. ASDC J. Dent. Child. 1997 (Jan-Feb);64(1):55-60.
60. Bureau of Labor Statistics, U.S. Department of Labor.
61. Coca-Cola Co. Annual Report, 1997; M. Douglas Ivester’s introductory statement.
62. Coca-Cola Co. Annual Report, 1997.
63. Arkansas Department of Finance and Administration, Little Rock, AR.
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