title: Healthier choices in an Australian health service: a pre-post audit of an intervention to improve the nutritional value of foods and drinks in vending machines and food outlets.
abstract: BACKGROUND
  Vending machines and shops located within health care facilities are a source of food and drinks for staff, visitors and outpatients and they have the potential to promote healthy food and drink choices. This paper describes perceptions of parents and managers of health-service located food outlets towards the availability and labelling of healthier food options and the food and drinks offered for sale in health care facilities in Australia. It also describes the impact of an intervention to improve availability and labelling of healthier foods and drinks for sale.
  
  
  METHODS
  Parents (n = 168) and food outlet managers (n = 17) were surveyed. Food and drinks for sale in health-service operated food outlets (n = 5) and vending machines (n = 90) in health care facilities in the Hunter New England region of NSW were audited pre (2007) and post (2010/11) the introduction of policy and associated support to increase the availability of healthier choices. A traffic light system was used to classify foods from least (red) to most healthy choices (green).
  
  
  RESULTS
  Almost all (95%) parents and most (65%) food outlet managers thought food outlets on health service sites should have signs clearly showing healthy choices. Parents (90%) also thought all food outlets on health service sites should provide mostly healthy items compared to 47% of managers. The proportion of healthier beverage slots in vending machines increased from 29% to 51% at follow-up and the proportion of machines that labelled healthier drinks increased from 0 to 26%. No outlets labelled healthier items at baseline compared to 4 out of 5 after the intervention. No changes were observed in the availability or labelling of healthier food in vending machines or the availability of healthier food or drinks in food outlets.
  
  
  CONCLUSIONS
  Baseline availability and labelling of healthier food and beverage choices for sale in health care facilities was poor in spite of the support of parents and outlet managers for such initiatives. The intervention encouraged improvements in the availability and labelling of healthier drinks but not foods in vending machines.
authors.affiliation: Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia. Libby.Campbell@hnehealth.nsw.gov.au.
authors.forename: Colin
authors.initials: C
authors.lastname: Bell
authors.forename: Nicole
authors.initials: N
authors.lastname: Pond
authors.forename: Lynda
authors.initials: L
authors.lastname: Davies
authors.forename: Jeryl Lynn
authors.initials: JL
authors.lastname: Francis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Campbell
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
mesh_terms: D001628:Beverages / Q000592:standards; D003625:Data Collection; D005502:Food / Q000592:standards; D005509:Food Dispensers, Automatic / Q000592:standards*; D005515:Food Labeling; D005523:Food Supply / Q000592:standards*; D006268:Health Facilities / Q000592:standards*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D009517:New South Wales; D009753:Nutritive Value