title: The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program.
abstract: BACKGROUND
  Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations.
  
  
  OBJECTIVE
  This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments.
  
  
  METHODS
  Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products.
  
  
  RESULTS
  Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines.
  
  
  CONCLUSIONS
  According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.
authors.affiliation: Samuels & Associates, Oakland, California, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Lawrence
authors.forename: Maria
authors.initials: M
authors.lastname: Boyle
authors.forename: Lisa
authors.initials: L
authors.lastname: Craypo
authors.forename: Sarah
authors.initials: S
authors.lastname: Samuels
mesh_terms: D001628:Beverages; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D005509:Food Dispensers, Automatic / Q000706:statistics & numerical data*; D005522:Food Services / Q000458:organization & administration*; D006268:Health Facilities / Q000706:statistics & numerical data* / Q000639:trends; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D018673:Nutrition Policy; D009753:Nutritive Value; D009765:Obesity / Q000517:prevention & control; D015397:Program Evaluation; D011634:Public Health; D012111:Residence Characteristics