Facilitators and Barriers to Developing, Implementing, and Evaluating Healthy Vending Policies in Four Cities.

Vending machines are a common source of low-nutrient, energy-dense snacks, and beverages. Many cities are beginning to adopt healthy vending policies in public areas, but evidence regarding best practices for developing, implementing, and evaluating these healthy vending polices is limited. This study used a mixed-methods, multiple case study design to examine healthy vending policies and initiatives in four cities. Data were collected between August 2017 and December 2017. Research staff worked with a designated contact person to coordinate site visits to each city where observations of the vending machines were conducted. Semistructured interviews were conducted with multiple stakeholders from each site and documents, including policies, vendor contracts, and nutrition standards, were reviewed. The following elements were identified as being essential to a healthy vending policy or initiative: having a champion and support from leadership, internal and external partnerships, and clear communication. Conducting regular compliance checks of the vending machines and the ability to obtain sales data, especially pre- and post-healthy vending policy sales data, continues to be a challenge. Stakeholders across all cities reported that concerns about profit-loss from the vendor and city revenue and procurement departments are barriers to adopting healthy vending policies. More research and evaluation are needed, as results are mixed regarding the impact on overall revenue/profits. This study yielded a variety of resources and "lessons learned" from those who have developed and implemented healthy vending policies and initiatives. This information should be used by others looking to influence healthier snacking behaviors through vending machines.