Are Vending Machine Selections Healthier? Trends in Dietary Quality of Vending Machine Food and Beverage Selections Among NHANES Participants Age 6-19 Years Between 2003 - 201

Dietary intake is related to 4 major causes of death and may be influenced by the food environment, which includes the $64.3 billion revenue-producing vending machine industry. Most machines contain low nutrient energy dense foods and beverages associated with poor dietary choices, while healthier vending initiatives are seen as a strategy to increase access to healthy foods. Elementary and secondary schools have increasingly adopted healthier vending standards in response to federal child nutrition regulation and student wellness policy implementation, however an association between vending and diet has not been made using a large sample of nationally representative data. The purpose of this cross-sectional study was to compare the overall dietary quality among National Health and Nutrition Examination Survey (NHANES) participants age 6--19 years relative to foods and beverages sourced from vending machines. Healthy Eating Index (HEI-2010) scores were derived using ten years of NHANES dietary interview data collected from 2003--2012. Quantitative statistical analyses were used to test for significant differences among mean HEI-2010 scores. Kcal consumption decreased and diet quality modestly improved over the years among children who use vending machines, though vending machine use was negatively associated with dietary quality. These findings provide evidence in support of national policy designed to improve dietary intake in children, that should over time, help lead the next generation of children to live healthier lives.