Target Behavior: Healthy Eating
Intervention Type: PSE Change
Intervention Reach and Adoption
As an institutional policy, the procurement motion specifically targets 100,000 + County employees; patrons who purchase food and beverages at County venues, and populations whose meals are provided by County of Los Angeles food venues and programs. The County distributes meals to youth, seniors, patients, and incarcerated individuals; populations who are at greater risk for developing nutrition-related chronic diseases and those who are economically disadvantaged. DPH estimated that motions would impact the nutritional quality of approximately 37 million meals offered/sold in various County operated settings per year.
 California Health Interview Survey. CHIS 2020. Los Angeles, CA: UCLA Center for Health and Policy Research, Los Angeles, CA. Retrieved February 2, 2022.
 Obesity Rates for Youth Ages 10 to 17. Oct. 2021. State of Childhood Obesity. Retrieved February 2, 2022.
 Key Indicators of Health by Service Planning Area. January 2017. Los Angeles County Department of Public Health. Retrieved February 2, 2022.
Setting: Community, Retail, Worksite
Target Audience: Preschool (<5 years old), Elementary School, Middle School, High School, Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults , Older Adults
- Institutional policy should include evidence-based nutrition standards, as well as other healthy food procurement strategies that promote selection/consumption of healthy foods and beverages.
- Institutional policy should designate an organization or formal group to coordinate implementation of new nutrition standards and other promotion strategies.
- The coordinating organization should consult with stakeholders whom the institutional policy will impact, such as food service vendors and department leadership in charge of food service contracts. This step must precede policy implementation.
- The coordinating organization should have adequate resources to oversee institutional policy implementation, including sufficient resources to offer ongoing technical assistance and evaluation.
- An organization or formal group should be authorized to evaluate and monitor the institutional policy or system change. In Los Angeles County, the coordinating organization (Los Angeles County Department of Public Health) also serves as the entity that evaluates and monitors policy implementation.
- Model policy– Healthy Food Promotion in LA County Food Service Contracts
- “Creating Healthy Food Environments” policy brief
- Nutrition Standards – Nutrition Standards for Prepared Foods, Snacks, and Beverages (–2021) revision to Los Angeles County’s current nutrition standards
- Board motion 3.115 County of Los Angeles Vending Machine Nutrition Policy, the most recently adopted vending machine nutrition policy
- Case study on the vending machine program
- Policy brief on working with public and private hospitals
- Eat Your Best Promotional and technical assistance resources including signage posters, implementation guides, and a and cookbook to promote plant-forward menus
Designated staffing for implementation and evaluation is needed to sustain the intervention.
The initial assessment involved an extensive survey of the settings (e.g., cafeterias, vending machines, and concessions), practices (current nutrition standards, dietary accommodations), and challenges anticipated by each County department. Since 2011, DPH has partnered with 7 County departments including the Probation Department, Department of Public Works, Department of Health Services, Department of Children and Family Services, Department of Parks and Recreation, Department of Beaches and Harbors, and the Chief Executive Office. DPH provided technical assistance to each department, conducted site visits and menu reviews, recommended and integrated DPH nutrition standards in County contract solicitation and operational processes, and established a monitoring and compliance system.
An adapted version of the validated Nutrition Environment Measures Survey for Vending Machines (NEMS-V) tool and an internally developed environmental scan tool for cafeterias were used to collect baseline and follow-up data on the food and beverage options offered in vending machines and cafeterias at select facility locations. To date, we have collected baseline data on food and beverages that are offered in 45 County hospitals and multiple worksite cafeterias.
Vendor quarterly revenue, product sales records, and nutritional information of vending machine snacks and beverages were collected to examine the level of adherence and impact of 100% healthy vending policy at a large urban agency in Los Angeles County. A key finding was that policy adherence increased for snacks and beverages sold in County vending machines at the start and 23 months after implementing the policy; from ~32% to ~61% for snacks and ~50% to ~98% for beverages. However, average snack and beverage revenues appeared to decrease during the sampled period for snacks and beverages by ~37% and ~34%, respectively. DPH also conducted an environmental scan sub-assessment, and found a 32% price increases for vended snacks and beverages occurred shortly after the implementation of the policy. To some extent, this may explain the decreases in snack and beverage revenue.
DPH plans to continue technical assistance through the dissemination of healthy food procurement toolkits, and promotion of model procurement guidelines for a variety of venues and institutions. The DPH evaluation team has published several articles pertaining to healthy food procurement work and has several manuscripts in development that document the challenges and successes of creating healthier food environments. Contribution to this evidence base provides valuable information for informing similar efforts in other sectors (e.g., cities, private companies, community-based organizations with food services).
 Wickramasekaran et al. (2018). Evaluating the Potential Health and Revenue Outcomes of a 100% Healthy Vending Machine Nutrition Policy at a Large Agency in Los Angeles County, 2013-2015. Journal of Public Health Management and Practice, 24(3), 215-224 DOI: 10.1097/PHH.0000000000000702
|Readiness and Capacity – Short Term (ST)||Changes – Medium Term (MT)||Effectiveness and Maintenance – Long Term (LT)||Population Results (R)|
|Sectors of Influence||MT7|
- Salad Bar Toolkit
Michelle Wood, MPP
Program Manager, Food Policy Initiatives
Division of Chronic Disease and Injury Prevention
Los Angeles County Department of Public Health
3530 Wilshire Blvd., 8th Floor
Los Angeles, CA 90010
Phone: (213) 351-7809