Effectiveness of Nutrition Interventions in Vending Machines to Encourage the Purchase and Consumption of Healthier Food and Drinks in the University Setting: A Systematic Review

Improving student diet and food security in higher education using participatory and co-creation approaches: a systematic review

BACKGROUND

Higher education students are an important target group for public health nutrition interventions. When designing tailored and contextually relevant interventions, participatory and co-creation approaches are increasingly recognized as promising but their use and effectiveness has not been assessed in this type of population. We systematically reviewed interventions aiming to improve dietary quality and/or food security in higher education settings with the aims 1) to identify and describe their participatory and co-creation approaches and 2) to compare the effectiveness of interventions using or not using participatory and co-creation approaches.

METHODS

Our search in PubMed, Google Scholar, Web of Science, EMBASE was performed in January 2023 and yielded 3658 unique records, out of which 42 articles (66 interventions) were included. Effectiveness of interventions was assessed at the individual level (longitudinal evaluations) or at the group level (repeated cross-sectional evaluations). A five-level classification was used to describe a continuum of engagement from students and other partners in the intervention design and implementation: no participation (level one), consultation, co-production, co-design and co-creation (levels two to five). To synthetize effectiveness, comparisons were made between studies without participation (level one) or with participation (levels two-five).

RESULTS

Ten (24%) out of 42 studies used a participatory and co-creation approach (levels two-five). Studies using a participatory and co-creation approach reported a positive finding on individual-level outcome (i.e. overall diet quality or food group intake or food security) in 5/13 (38%) intervention arms (vs 13/31 or 42% for those without participation). Studies using a participatory and co-creation approach reported a positive finding on group-level outcomes (i.e. food choices in campus food outlets) in 4/7 (57%) (vs 8/23 or 35% in those without participation).

CONCLUSIONS

Participatory and co-creation approaches may improve the effectiveness of nutrition interventions in higher education settings but the level of evidence remains very limited. More research is warranted to identify best co-creation practices when designing, implementing and evaluating nutritional interventions in the higher education setting.

TRIAL REGISTRATION

PROSPERO registration number CRD42023393004.

Characterizing Healthy Dietary Practices in Japan: Insights from a 2024 Nationwide Survey and Cluster Analysis

The increasing burden of lifestyle-related diseases highlights the need to address unhealthy dietary habits. This study aims to explore the latest dietary patterns in Japan following the COVID-19 pandemic, focusing on trends in health-promoting food choices. A web-based survey was conducted among 27,154 Japanese adults, selected via quota sampling to mirror national demographics. The study evaluated dietary diversity, measured through the Dietary Variety Score (Outcome 1), and the prioritization of nutritional and health considerations in food selection, assessed via a Likert scale (Outcome 2). Uniform Manifold Approximation and Projection (UMAP) and Ordering Points To Identify the Clustering Structure (OPTICS) algorithms were used to delineate patterns in health-centric food selections. OPTICS clustering revealed four distinct clusters for each outcome. Cluster 3, with a diverse diet, comprised older, predominantly female individuals with higher well-being and lower social isolation compared to Cluster 4, which lacked distinct dietary patterns. Cluster 3 also engaged more in snacking, treat foods, home cooking, and frozen meals. Similarly, a divide emerged between those prioritizing dietary considerations (Cluster C) and those indifferent to such aspects (Cluster D). The findings underscore the need for holistic post-COVID-19 public health initiatives addressing socioeconomic and cultural barriers to healthier dietary practices.

Benchmarking the university campus food environment and exploring student perspectives about food insecurity and healthy eating: a case study from Australia

OBJECTIVE

To benchmark the university food environment and explore students' experiences with food insecurity and healthy eating in order to inform interventions to improve access and affordability of healthy foods for university students.

DESIGN

A food environment audit was conducted on the university campus using the Uni-Food tool from April to May 2022 and was comprised of three main components, university systems and governance, campus facilities and environment, and food retail outlets. A qualitative study design was also used to conduct focus groups and semi-structured interviews with students to explore key themes regarding their experiences with food insecurity and healthy eating.

SETTING

Macquarie University, Australia.

PARTICIPANTS

For the food environment audit 24 retail outlets on campus and for the qualitative component 29 domestic and international students enrolled at Macquarie University.

RESULTS

The university only scored 27% in total for all components in the food environment audit. The results showed the need for better governance and leadership of the food environment. The qualitative component suggested that the main barriers to accessing healthy foods were related to availability, pricing, and knowledge of healthy foods. Future intervention ideas included free fruits and vegetables, food relief, discounts, improved self-catering facilities, education, and increased healthy food outlets.

CONCLUSIONS

Improving governance measures related to healthy eating on campus are a core priority to strengthen the food environment and students identified pricing and availability as key issues. These findings will inform effective and feasible interventions to improve food security and healthy eating on campus.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

Perception about the effectiveness of different vending machine interventions to promote healthier snack selection among college students

OBJECTIVE

Evaluate college students' perception of the effectiveness of different vending machine (VM) interventions for improving snack selection.

PARTICIPANTS

A total of 194 college students with the age of ≥18 years.

METHOD

A cross-sectional survey among a purposive sampling near VM.

RESULTS

Most students use VM frequently or occasionally (63.4%). The intervention perceived as most helpful for choosing healthier snacks was labeling (on or near) which snack is healthy (score 3.83/5) followed by lowering the price of healthy options (score 3.33/5), while the least helpful was having posters nearby explaining which snacks are healthier (2.35/5). Participants suggested including snacks high in protein (58.8%) and low in sugar (56.2%). Most would like to see more healthy options in VM (83.5%) and will purchase them if available (67%).

CONCLUSIONS

Lowering the price for healthy snacks and including labels to indicate which are healthy may be the interventions to test for improving snack intake among college students.

Healthy Food Policies Documented in University Food Service Contracts

In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations.

Factors Generating the Willingness of Romanian Consumers to Buy Raw Milk from Vending Machines

The use of automatic raw milk dispensers for products obtained from Romanian farms can represent an effective method of encouraging the development of short supply chains and promoting sustainable production and consumption systems. There are very few studies in the literature, especially in emerging economies, that analyze consumer perception regarding the use of raw milk dispensers; most of the research is focused on technical aspects regarding how such machines function and food safety, and less on consumers' perceptions towards them or consumer satisfaction, loyalty, or intention to use them. Therefore, the objective of this research was to investigate the willingness of Romanian consumers to buy raw milk from vending machines. In this regard, the authors drew a conceptual model to assess the factors that trigger willingness to buy raw milk from vending machines and then implemented a quantitative-based survey among Romanian consumers who buy raw milk from vending machines. The data were analyzed by modeling structural equations with SmartPLS. The results reveal that the generation of consumer willingness to buy raw milk from vending machines depends on how consumers perceive raw milk but also on the product safety, reusability of the milk bottle, and the provenance of the raw milk, as well as the nutritional qualities of the unprocessed raw milk. The paper extends previous studies based on the stimulus-organism-response (SOR) and deepens the understanding of consumers' perception towards raw milk dispensers. Furthermore, the results also highlight possible managerial strategies that aim to improve the understanding of consumers.

A College Fast-Food Environment and Student Food and Beverage Choices: Developing an Integrated Database to Examine Food and Beverage Purchasing Choices among College Students

Universities typically offer residential students a variety of fast-food dining options as part of the student meal plan. When residential students make fast-food purchases on campus there is a digital record of the transaction which can be used to study food purchasing behavior. This study examines the association between student demographic, economic, and behavioral factors and the healthfulness of student fast-food purchases. The 3781 fast-food items sold at the University of North Carolina at Charlotte from fall 2016 to spring 2019 were given a Fast-Food Health Score. Each student participating in the university meal plan was given a Student Average Fast-Food Health Score; calculated by averaging the Fast-Food Health Scores associated with each food and beverage item the student purchased at a fast-food vendor, concession stand, or convenience store over a semester. This analysis included 14,367 students who generated 1,593,235 transactions valued at $10,757,110. Multivariate analyses were used to examine demographic, economic, and behavioral factors associated with Student Average Fast-Food Health Scores. Being of a low income, spending more money on fast-food items, and having a lower GPA were associated with lower Student Average Fast-Food Health Scores. Future research utilizing institutional food transaction data to study healthy food choices is warranted.

Consumption, Attitudes, and Trends of Vending Machine Foods at a University Campus: A Cross-Sectional Study

Vending machines (VMs) have been identified as an obesogenic factor, offering mainly energy-dense and nutrient-poor foods, with limited healthy options available. This cross-sectional study aimed to assess consumption trends and attitude toward vending machine (VM) foods in a university setting. A web-based survey was conducted among 1250 students and staff. Most participants reported weight gain (43.4%) and poorer food choices (53.4%) since joining the university. Participants described VM foods as expensive (53.7%) and lacking variety (34.3%). Over 81% demanded the availability of healthier options. About 75% of participants were VMs users. The most frequently purchased VM items were water, chocolate, and chips. Males reported consuming nuts, soda, iced tea, and energy drinks more frequently than females (p < 0.005). The main reasons for using the VM were hunger and lack of time. Over 40% nominated fresh fruits, baked chips, sandwiches, and dry roasted nuts to be provided in the VMs as healthier food options. Males and those responsible for buying their own food were more likely to select healthier options (p = 0.001). Findings can be used to inform stakeholders of current vending behaviors and to plan tailored interventions to improve the nutritional quality of vended items and promote healthier food choices.

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

BACKGROUND

Given the lack of data about the nutritional value and other determinants of the consumption of foods and drinks sold in vending machines in European universities and the relevance of this sector in Spain, it is necessary to obtain scientific data on this topic. The present study aimed to assess the availability, nutritional profile and processing level of food products from vending machines at a Spanish public university and to investigate differences in nutritional profile according to the cost and promotion.

METHODS

Cross-sectional descriptive study. Data from all products available (3894) were collected and analysed using the criteria of the Spanish Agency for Consumption, Food Safety and Nutrition and the United Kingdom nutrient profiling model. The items were also classified according to the degree of industrial processing through the NOVA system. Promotion was assessed, taking into account where products were displayed in vending machines.

RESULTS

The most common products were sweets (23.4% of the total options), coffee (20.3%) and salty snacks (11.7%). According to the combination of the two criteria used to assess nutritional profile, 48.6% of the products were classified as with low nutritional quality (LNQ). In addition, 73.8% of the items were categorised as "ultra-processed". Foods (β = 0.31, 95% CI 0.24, 0.39, p < 0.001) and hot drinks (β = 0.46, 95% CI 0.39, 0.52, p < 0.001) with high nutritional quality (HNQ) were more likely to have higher prices than alternatives with LNQ. Both foods and cold drinks that support healthy dietary recommendations were promoted to a lesser extent than those with LNQ (p < 0.001).

CONCLUSION

Almost half of the products were of LNQ and three-quarters had a high level of processing. Moreover, foods and cold drinks with LNQ were less expensive and more often promoted than alternatives with HNQ.

Favorable Commercial and Health Behavior Impacts of a Healthy Vending Policy at an Australian University

BACKGROUND

The World Health Organization recognizes universities as an important health-promotion setting, including in healthy food provision. Previous research shows that healthy food retail interventions also need to consider commercial sustainability, including financial outcomes, and should take a holistic approach to consumer experience.

OBJECTIVE

Our aim was to determine the health behavior and commercial outcomes of a multicomponent traffic light-based healthy vending policy implemented as one part of a holistic university food policy. The hypothesis was that purchases of less healthy "red" beverages would decrease compared with predicted sales, that purchases of healthier "green" and "amber" alternatives would increase, and that there would be no change in revenue.

DESIGN

A quasi-experimental design evaluated a real-world food policy using monthly aggregated sales data to compare pre-intervention (January 2016 to March 2018) and post-intervention period sales (December 2018 to December 2019).

PARTICIPANTS/SETTING

Electronic sales data were collected from 51 beverage vending machines across 4 university campuses in Victoria, Australia.

INTERVENTION

A multicomponent policy was implemented between April and November 2018. Beverages were classified using a voluntary state government traffic light framework. Policy included display ≤20% red beverages and ≥50% green beverages; machine traffic light labeling; health-promoting machine branding; review of machine placement; and recycled bottle packaging.

MAIN OUTCOME MEASURES

Changes in red, amber, and green volume sales, and revenue compared with predicated sales.

STATISTICAL ANALYSES PERFORMED

Interrupted time series analysis of sales data compared post-policy sales with predicted sales.

RESULTS

In the 13^th month post-policy implementation, there was a 93.2% (95% CI +35.9% to +150.5%) increase in total beverage volume sold and an 88.6% (95% CI +39.2% to +138.1%) increase in revenue. There was no change in red beverage volume sold, but increases in green (+120.8%; 95% CI +59.0% to +182.6%) and amber (+223.2%; 95% CI +122.4% to +323.9%) volume sold.

CONCLUSIONS

Sustained behavior change and commercial outcomes suggest that holistic vending interventions can effectively promote healthier beverage sales.

Characterization, Nutrient Intake, and Nutritional Status of Low-Income Students Attending a Brazilian University Restaurant

In Brazilian universities, the university restaurant (UR) is essential in supporting students to complete their courses, as the UR offers free or low-cost food. In this sense, this research aimed to evaluate public policy effectiveness in offering food to low-income students attending the UR of the University of Brasília. This cross-sectional study compared low-income students (participating in the Student Assistance Program—Group 1) and students that did not participate in the Program (Group 2). Researchers assessed food consumption through direct observation of students while serving their plates at UR (in all meals consumed at UR) and completed food consumption with diet recalls for the meals outside the UR. In total, three complete days, including one weekend day, were evaluated for each student. Researchers also evaluated the participants’ body mass composition and body fat percentage. The results of the comparisons between the evaluated groups showed that the groups presented similar intakes. Only sodium intake was significantly different for males, being higher for Group 1. The median sodium consumption among females and males in group 1 was 55% and 119%, respectively, above the upper limit (UL). In Group 2, sodium intake levels reached consumption percentages above UL by 36% for females and 79% for males. The prevalence of inadequate sodium consumption was 100% for both genders and groups. Extra salt was added to dishes by 19.7% of the students. For females, only fiber ingestion was statistically different, with higher intake for Group 1. The other evaluated parameters showed similarities among groups for each gender. The statistical analysis revealed a significant difference in the consumption of calories, fibers, sodium, iron, and calcium for the students who had three meals at the UR in the two weekdays. There was a statistical difference in nutrients for those who had three meals in the UR, reinforcing the importance of the UR’s meals. The current food and nutrition policy at the UR proved to be extremely important in university students’ lives and in maintaining healthy nutritional aspects. However, changes in sodium use, more calcium intake, and less cholesterol consumption should receive attention to better balance dietary elements of the food offered. Dish preparation should be carefully followed to ensure the quality of the food for university students.