- freely available
Nutrients 2018, 10(2), 216; https://doi.org/10.3390/nu10020216
2. Materials and Methods
2.1. Policy Context
2.3. Geographic Context
2.4. Data Collection
2.5. Study Outcomes
2.5.1. Product Availability
2.5.2. Portion Size and Product Quality
- Compliant Everyday or Occasional food and drinks: met the maximum portion size and quality guidelines.
- Everyday food and drinks exceeding portion size (e.g., >400 mL fruit juice or >500 mL flavoured milk).
- Below quality Everyday food and drinks: contained “do not use” ingredients as identified from the product ingredient lists (e.g., muesli bars and nut mixes with added confectionary).
- Occasional food and drinks exceeding portion size (e.g., >280 g meat pie or >500 mL diet drink)
- Below quality Occasional food and drinks: contained “do not use” ingredients (e.g., hot meal with sour cream or any sugary drink, such as soft drinks, fruit drinks, sweetened iced teas, and energy and sports drinks) .
2.5.3. Packaged Product Quality
2.5.4. Placement and Promotion
2.6. Data Analysis
3.2. Product Quality
3.3. Product Size
3.4. Placement and Promotion
Strengths and Limitations
Conflicts of Interest
|All Occasional |
|Proportion Sugary |
|Hospital A †||35||492||7%|
|Products Exceeding |
|Total||Proportion Exceeding |
- Australian Bureau of Statistics. Australian Health Survey: Nutrition First Results, 2014–15; Commonwealth of Australia: Canberra, ACT, Australia, 2015.
- Australian Bureau of Statistics. Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines; Commonwealth of Australia: Canberra, ACT, Australia, 2016.
- Commonwealth of Australia. Healthy Food Partnership. Available online: http://www.health.gov.au/internet/main/publishing.nsf/content/healthy-food-partnership (accessed on 8 November 2017).
- Public Health Association fo Australia. Policy-at-a-Glance--Food, Nutrition and Health Policy; Public Health Association of Australia: Deakin, ACT, Australia, 2012. [Google Scholar]
- Kelly, B.; Flood, V.M.; Yeatman, H. Measuring local food environments: An overview of available methods and measures. Health Place 2011, 17, 1284–1293. [Google Scholar] [CrossRef] [PubMed]
- Bell, C.; Pond, N.; Davies, L.; Francis, J.L.; Campbell, E.; Wiggers, J. 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. BMC Health Serv. Res. 2013, 13, 492. [Google Scholar] [CrossRef] [PubMed]
- Lawrence, S.; Boyle, M.; Craypo, L.; Samuels, S. The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program. Pediatrics 2009, 123 (Suppl. 5), S287–S292. [Google Scholar] [CrossRef] [PubMed]
- Australian Institute of Health and Welfare. Australia's Hospitals at a Glance 2015–16; AIHW: Canberra, ACT, Australia, 2017.
- New South Wales Ministry of Health. Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework; NSW Ministry of Health: North Sydney, NSW, Australia, 2017.
- New South Wales Ministry of Health. Live Life Well @ Health: Healthier Food and Drink Choices—Staff & Visitors in NSW Health Facilities; NSW Ministry of Health: North Sydney, NSW, Australia, 2009.
- National Health and Medical Research Council. Australian Dietary Guidelines Summary; National Health and Medical Research Council: Canberra, ACT, Australia, 2013. [Google Scholar]
- Commonwealth of Australia. About Health Star Ratings. Available online: http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/About-health-stars (accessed on 20 September 2017).
- Roy, R.; Hebden, L.; Kelly, B.; De Gois, T.; Ferrone, E.M.; Samrout, M.; Vermont, S.; Allman-Farinelli, M. Description, measurement and evaluation of tertiary-education food environments. Br. J. Nutr. 2016, 115, 1598–1606. [Google Scholar] [CrossRef] [PubMed]
- Kelly, B.; Flood, V.M.; Bicego, C.; Yeatman, H. Derailing healthy choices: An audit of vending machines at train stations in nsw. Health Promot. J. Aust. 2012, 23, 73–75. [Google Scholar] [CrossRef]
- Reilly, K.; Hunter New England Population Health, New Lambton, NSW, Australia. Personal communication, 2017.
- .id-the Population Experts. State of Australia’s Fast Growing Outer Suburbs. Available online: https://ngaa.org.au/pdfs/ngaa-research-state-of-the-fast-growing-outer-suburbs-part-1-july-2017.pdf (accessed on 31 October 2017).
- Astell-Burt, T.; Feng, X.; Kolt, G.S.; McLean, M.; Maberly, G. Understanding geographical inequities in diabetes: Multilevel evidence from 114,755 adults in Sydney, Australia. Diabetes Res. Clin. Pract. 2014, 106, e68–e73. [Google Scholar] [CrossRef] [PubMed]
- NSW Government Western Sydney Local Healthy District. WSLHD 2016–17 Year in Review; WSLHD: Western Sydney, NSW, Australia, 2017.
- Landon, S.; NSW Ministry of Health, North Sydney, Australia. Personal communication, 2017.
- NSW Department of Education. Healthy School Canteens: Summary of Evidence in Inform a Revised Strategy; NSW Department of Education: Sydney, Australia, 2016.
- Dunford, E.; Trevena, H.; Goodsell, C.; Ng, K.; Webster, J.; Millis, A.; Goldstein, S.; Hugueniot, O.; Neal, B. Foodswitch: A mobile phone app to enable consumers to make healthier food choices and crowdsourcing of national food composition data. JMIR Mhealth Uhealth 2014, 2, e37. [Google Scholar] [CrossRef] [PubMed]
- Wu, J.H.; Neal, B.; Trevena, H.; Crino, M.; Stuart-Smith, W.; Faulkner-Hogg, K.; Yu Louie, J.C.; Dunford, E. Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in australia. Br. J. Nutr. 2015, 114, 448–454. [Google Scholar] [CrossRef] [PubMed]
- Winston, C.P.; Sallis, J.F.; Swartz, M.D.; Hoelscher, D.M.; Peskin, M.F. Consumer nutrition environments of hospitals: An exploratory analysis using the hospital nutrition environment scan for cafeterias, vending machines, and gift shops, 2012. Prev. Chronic Dis. 2013, 10, 1–9. [Google Scholar] [CrossRef] [PubMed]
- Derrick, J.W.; Bellini, S.G.; Spelman, J. Research: Using the hospital nutrition environment scan to evaluate health initiative in hospital cafeterias. J. Acad. Nutr. Diet. 2015, 115, 1855–1860. [Google Scholar] [CrossRef] [PubMed]
- Lesser, L.I.; Hunnes, D.E.; Reyes, P.; Arab, L.; Ryan, G.W.; Brook, R.H.; Cohen, D.A. Assessment of food offerings and marketing strategies in the food-service venues at california children’s hospitals. Acad. Pediatr. 2012, 12, 62–67. [Google Scholar] [CrossRef] [PubMed]
- McDonald, C.M.; Karamlou, T.; Wengle, J.G.; Gibson, J.; McCrindle, B.W. Nutrition and exercise environment available to outpatients, visitors, and staff in children’s hospitals in canada and the united states. Arch. Pediatr. Adolesc. Med. 2006, 160, 900–905. [Google Scholar] [CrossRef] [PubMed]
- Zheng, M.; Rangan, A.; Meertens, B.; Wu, J.H.Y. Changes in typical portion sizes of commonly consumed discretionary foods among australian adults from 1995 to 2011–2012. Nutrients 2017, 9, 577. [Google Scholar] [CrossRef] [PubMed]
- Nielsen, S.J.; Popkin, B.M. Patterns and trends in food portion sizes, 1977–1998. JAMA 2003, 289, 450–453. [Google Scholar] [CrossRef] [PubMed]
- Matthiessen, J.; Fagt, S.; Biltoft-Jensen, A.; Beck, A.M.; Ovesen, L. Size makes a difference. Public Health Nutr. 2003, 6, 65–72. [Google Scholar] [CrossRef] [PubMed]
- Kling, S.M.; Roe, L.S.; Keller, K.L.; Rolls, B.J. Double trouble: Portion size and energy density combine to increase preschool children’s lunch intake. Physiol. Behav. 2016, 162, 18–26. [Google Scholar] [CrossRef] [PubMed]
- McCrickerd, K.; Lim, C.M.; Leong, C.; Chia, E.M.; Forde, C.G. Texture-based differences in eating rate reduce the impact of increased energy density and large portions on meal size in adults. J. Nutr. 2017, 147, 1208–1217. [Google Scholar] [CrossRef] [PubMed]
- Sharma, S.V.; Winston Paolicelli, C.; Jyothi, V.; Baun, W.; Perkison, B.; Phipps, M.; Montgomery, C.; Feltovich, M.; Griffith, J.; Alfaro, V.; et al. Evaluation of worksite policies and practices promoting nutrition and physical activity among hospital workers. Int. J. Workplace Health Manag. 2016, 9, 46–62. [Google Scholar] [CrossRef]
- Roy, R.; Kelly, B.; Rangan, A.; Allman-Farinelli, M. Food environment interventions to improve the dietary behavior of young adults in tertiary education settings: A systematic literature review. J. Acad. Nutr. Diet. 2015, 115, 1647–1681. [Google Scholar] [CrossRef] [PubMed]
- Crino, M.; Herrera, A.M.M.; Ananthapavan, J.; Wu, J.H.Y.; Neal, B.; Lee, Y.Y.; Zheng, M.; Lal, A.; Sacks, G. Modelled cost-effectiveness of a package size cap and a kilojoule reduction intervention to reduce energy intake from sugar-sweetened beverages in Australia. Nutrients 2017, 9, 983. [Google Scholar] [CrossRef] [PubMed]
- Crino, M.; Sacks, G.; Wu, J.H.Y. A review of population-level actions targeting reductions in food portion sizes to address obesity and related non-communicable diseases. Curr. Nutr. Rep. 2016, 5, 323–332. [Google Scholar] [CrossRef]
- Stanton, R.A. Food retailers and obesity. Curr. Obes. Rep. 2015, 4, 54–59. [Google Scholar] [CrossRef] [PubMed]
- Cohen, D.A.; Babey, S.H. Contextual influences on eating behaviours: Heuristic processing and dietary choices. Obes. Rev. 2012, 13, 766–779. [Google Scholar] [CrossRef] [PubMed]
- Glanz, K.; Johnson, L.; Yaroch, A.L.; Phillips, M.; Ayala, G.X.; Davis, E.L. Measures of retail food store environments and sales: Review and implications for healthy eating initiatives. J. Nutr. Educ. Behav. 2016, 48, 280–288. [Google Scholar] [CrossRef] [PubMed]
- Huse, O.; Blake, M.R.; Brooks, R.; Corben, K.; Peeters, A. The effect on drink sales of removal of unhealthy drinks from display in a self-service cafe. Public Health Nutr. 2016, 19, 3142–3145. [Google Scholar] [CrossRef] [PubMed]
- Carrad, A.M.; Louie, J.C.; Milosavljevic, M.; Kelly, B.; Flood, V.M. Consumer support for healthy food and drink vending machines in public places. Aust. N. Z. J. Public Health 2015, 39, 355–357. [Google Scholar] [CrossRef] [PubMed]
- Rana, L.; Alvaro, R. Applying a health promoting schools approach to nutrition interventions in schools: Key factors for success. Health Promot. J. Aust. 2010, 21, 106–113. [Google Scholar] [CrossRef]
- Reilly, K.; Wyse, R.; Yoong, S.; Nathan, N. Is the banning of unhealthy foods at school canteens associated with principal influence or school policy? Obes. Res. Clin. Pract. 2014, 8, 85. [Google Scholar] [CrossRef]
- Boelsen-Robinson, T.; Backholer, K.; Corben, K.; Blake, M.R.; Palermo, C.; Peeters, A. The effect of a change to healthy vending in a major australian health service on sales of healthy and unhealthy food and beverages. Appetite 2017, 114, 73–81. [Google Scholar] [CrossRef] [PubMed]
- Abery, E.; Drummond, C. Implementation of mandatory nutritional guidelines in south australians primary school canteens: A qualitative study. Improv. Sch. 2014, 17, 41–53. [Google Scholar] [CrossRef]
- Bell, A.C.; Swinburn, B.A. School canteens: Using ripples to create a wave of healthy eating. Med. J. Aust. 2005, 183, 5–6. [Google Scholar] [PubMed]
- Gorton, D.; Carter, J.; Cvjetan, B.; Ni Mhurchu, C. Healthier vending machines in workplaces: Both possible and effective. N. Z. Med. J. 2010, 123, 43–52. [Google Scholar] [PubMed]
- NSW Ministry of Health. Nsw School Canteen Buyers’ Guide 2017. Healthy Kids Association Registered Products: Everyday and Occasional; NSW Ministry of Health: North Sydney, NSW, Australia, 2017.
|Café (n = 7)||Sells freshly prepared hot beverages and may sell a selection of pre-made fresh food products|
|Cafeteria (n = 5)||Sells either hot or cold fresh food products served to order, may also have a selection of premade food|
|Convenience store (n = 2)||Majority of items sold are manufacturer packaged products, limited fresh options available|
|Vending machine (n = 70)||Three types of vending machines were observed: food only, beverage only, or containing both food and beverage|
|No. of Outlets||≥75% of Total Everyday Products, n (%)||≥75% Everyday Food, n (%)||≥75% Everyday Drinks, n (%)|
|Fixed outlets||14||1 (7)||1 (7)||6 (43)|
|Vending machines||70||16 (23)||0||16 (23)|
|Fixed outlets||11||1 (9)||1 (9)||5 (45)|
|Vending machines||40||10 (25)||0||10 (25)|
|Fixed outlets||3||0||0||1 (33)|
|Vending machines||30||6 (20)||0||6 (20)|
|Outlet Type (n)||Food||Beverage|
|% Everyday Median (Range)||% Everyday Median (Range)|
|Fixed Outlet †|
|Café (7)||54 (23–67)||86 (64–92)|
|Cafeteria (5)||54 (20–82)||54 (45–64)|
|Convenience store (2)||14 (5–22)||30 (16–44)|
|p = 0.132||p = 0.005|
|Vending machines §|
|Beverage vending (39)||N/A||70 (50–100)|
|Mixed vending (8)||50 (42–65)||33 (31–35)|
|Food vending (23)||23 (13–54)||-|
|p < 0.001||p < 0.001|
|Product Placement n/N(%)||Advertisements * n/N(%)||Meal Deals n/N(%)|
|Hospitals Combined||9/14 (64)||6/9 (67)||12/28 (43)||6/9 (67)|
|Hospital A||7/11 (64)||5/7 (71)||3/15 (20)||2/5 (40)|
|Hospital B||2/3 (67)||1/2 (50)||9/13 (69)||4/4 (100)|
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