Choose Healthier Initiative: Design, Implementation and Effects of a Color-Coded Labeling Intervention on Vending Machines at an Urban Academic Medical Center.

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Capstone Committee:

Chair: Rickie Brawer, PhD, MPH, MCHES, Thomas Jefferson University

Shelley Chamberlain, RD, LDN, Thomas Jefferson University Hospital


In the past few decades obesity has risen dramatically in the US and has emerged as a national health problem. Centers for Disease Control and Prevention (CDC) reports indicate more than 35% of adults in the US are obese. Healthy People 2020, emphasizes the importance of community based programs to address obesity in non-traditional settings like worksites and schools. Vending machines are an integral part of our food environment. Studies show that vending machines typically carry unhealthy food. The Choose Healthier Initiative was created and implemented at Thomas Jefferson University and Thomas Jefferson University Hospitals with the aim of improving the vending environment. A color-coding criteria was developed for snacks and beverages in the vending machines. Items were color-coded into healthier (green), less healthy (yellow) and least healthy (red) groups. Messages were posted on vending machines to explain color-codes. Pre and Post color-code sales data were compared to find whether color-codes increased sales of healthy food and beverages and decreased the sales of unhealthy ones. A survey was conducted to assess whether color-codes had any effect on users’ choice of snacks and beverages. Study results indicate that there was a significant reduction in post color-code sales of unhealthy (red) snacks (P = 0.03). Additionally, the sales of healthier snacks and beverages increased though they were not statistically significant. Our survey results indicate 51% of the respondents used color codes to select snacks and beverages and 94% of those who used the color-codes agreed that color-codes helped them to make a better choice. These results of this study support that a simple color-coded labeling system is feasible and effective. As a result of this, Jefferson has planned to scale up the intervention.

Presentation: 21 minutes