Tuesday, May 13, 2014

Why LiVe Well Vending Machines Will Not Change Whether You Live Well: The Impact of Negative Messages of Youth – Angelina Telatovich

            It is common knowledge that lifestyle choices are associated with health outcomes. Somehow, despite knowing that healthy food and regular exercise can dramatically improve one’s health, many Americans maintain a lifestyle of high-sugar and high-fat diets without rigorous physical activity. According to the Center for Disease Control, obesity rates for adolescents have nearly quadrupled in the last thirty years (1). The Intermountain LiVe Well Campaign attempts to address healthy eating concerns among youths through an intervention known as the LiVe Well Vending Machine. As noted in their campaign, the machine “won’t take your money, and it won’t give you any snacks, but it may change how you think about eating junk food!” (2). The vending machines are placed in popular hang out areas for youths, such as schools or shopping malls. Although the snacks are visible through the machine, when someone actually presses a button for a snack, the machine says a funny comment about how the snack is unhealthy or why the customer may not want to eat it. For example, the machine may say “I don’t even like having this stuff inside me and I’m a vending machine…better me than you though!” or “It may taste good to your mouth, but your digestive system will make you pay for it later” or “Yeah, if you want someone to hold your hand, you should probably stop coating it with barbeque flavoring” or How about you run to the grocery store and pick up some fresh fruit or somethin’?  You could use a healthy snack and the run wouldn’t hurt either.” (2-3).
The vending machine is cited as a “good teaching tool” that would encourage children to think about what foods they are putting into their bodies (3). While the LiVe Vending Machine – like many other vending machines that are moving towards healthier choices– has good intentions, the intervention falls short of its goals to inspire change among youths. Intermountain Healthcare relies heavily on the Health Belief Model that the audience of these vending machines will rightfully change their behaviors just because they are told that eating junk food is bad for them; however, this information is often not enough to illicit behavior change, especially among a population who are already aware that junk food is not healthy (5). While the comments that the machine produces are meant to grab the attention of the children through humor, the machine actually accomplishes something rather different. Using negative messages and poking fun at those who enjoy eating junk food, the intervention encourages social reactance among its target audience (6). Additionally, negative labeling or “fat-shaming” can contribute to a self-fulfilling prophecy, bullying, and insecurities about body image among school age children (14). Lastly, the intervention falls short of its goals because it targets children at the individual level. According to the social learning theory, which claims people learn in social groups, an intervention is more likely to be effective if it targets a population (7). The LiVe Vending Machine does not change the social norms among youths because it does not create a unifying brand that youths want to be a part of.  The sustainability of a health intervention is only as effective as its ability to influence the perceived norm of a social group as a whole (8).
1. A Failure of the Health Belief Model for Generating Change
According to the Health Belief Model, the more an individual is informed about the risks associated with a habit, the more the individual will consider modifying their lifestyle (5). The model assumes people are capable of weighing the risks and benefits of whether or not they should adopt new habits. In the context of this paper, we would assume that people are capable of making informed decisions about their diet if given accurate information regarding foods. If this were true, why is obesity such a problem in our country? The LiVe Vending Machine intervention fails in large part because it assumes that children who interact with it are going to take away the message that they should eat better. The intervention does not consider the general awareness among young teenagers that junk food is unhealthy for them. Instead of focusing on core values that are important to young teenagers, Intermountain Healthcare has made the common mistake to focus on health as a core value. What many professionals in the healthcare field overlook is that young audiences do not value health. Although youths may be entirely aware that unhealthy food will impact their future health, youths are unrealistically optimistic that they will not experience the consequences of bad diet themselves (15). In effect, the audience is likely to listen to the vending machine, but ultimately, dismiss the important message that it attempts to deliver.
 Children and young teenagers are exposed to countless advertisements and campaigns every day encouraging Americans to make healthier food choices. Many of these advertisements have the same message: junk food is bad and you need to stop eating it. These advertisements fail to do more than remind people of health risks associated with their diet. Initially, the advertisement may spark a few individuals to consider how they can change their habits; however, constant exposure to the same message desensitizes much of the population. The LiVe Vending Machine is no exception. The machine is effective in grabbing one’s attention and the interactive nature is appealing to children. Nevertheless, once the audience has heard all of the witty comments that the machine has to offer, the audience has little need for it. Despite the vending machine’s attempt at humor, the machine does little to reinforce change. Even if children responded well to messages about health, the comments are superficial in nature. The humor aspect overpowers the machine’s ability to effectively convey messages with substance. Ultimately, if someone were to consider healthier eating, the machine’s messages do not illicit strong feelings about nutrition in the audience to successfully carry out new behaviors.  
2. Negative Labeling, Social Reactance, & A Self-Fulfilling Prophecy
            While the LiVe Vending Machine makes an effort through humor to paint nutrition as something fun and engaging, its comments do not send the right message to encourage healthier behaviors. Although the messages are delivered through jokes that appeal to the humor of youths, the messages have negative implications. Consider the statement “How about you run to the grocery store and pick up some fruit” (2). The comment immediately associates the consumer’s desire for a snack with being lazy. By associating purchases of unhealthy food with shameful labels, the intervention unintentionally encourages “fat shaming” among youths. According to an article in the Huffington Post, fat shaming “does not inspire anyone to change” and can actually have the opposite effect (10). Reminding consumers who choose to eat unhealthy foods of why those foods are bad for them elicits social reactance (10). According to the social reactance theory, attempts to influence a population “creates forces to comply and forces to react” depending on the perceived threat among the target population (6). This theory holds true especially among youths, who are more likely to engage in rebellious behavior if they feel their autonomy is threatened (11). When the machine says “this snack is better in me than in you” (2), youths can interpret this as patronizing. “How dare a machine tell me what I can do?” is a likely reaction. While the intervention may not be perceived as authoritative as a teacher or parent, the use of coercive statements is just as effective in eliciting social reactance among youths (6).
            Another implication of fat shaming is an increase in negative body images among youth and bullying (11). Consider the statement “Yeah, if you want someone to hold your hand, you should probably stop coating it with barbeque flavoring” (2). On the surface, this comment is a humorous reference to having messy hands after eating barbeque potato chips, but consider what the comment is not saying. In fact, this comment implies that someone who eats potato chips is not attractive or good enough for a peer to holding hands with. In effect, youths receive the message that they should deprive themselves of these foods in order to be worthy of the acceptance of their peers. Not only does this create unhealthy mindsets about body image, but also reinforces current messages in the media that being skinny is the only way to be healthy and popular. By extension, the messages that the machines produce demonstrate that it is acceptable for youths to label and put down their peers for choosing something that is unhealthy (10). It comes as little surprise that negative labeling is associated with a self-fulfilling prophecy among youths (10). If youths are told by their peers that they are going to become fat and unpopular, youths are more likely to believe that they have no control over their fate (14). Thus, youths may feel that there is no point to making changes to their diet. While social pressure and stigmatization of junk food can deter some youths from eating unhealthily, it encourages bullying among others who may not have the self-control or proper support to adopt healthier diets (10).
3.  Social Learning Theory & the Individual
The LiVe Vending Machine does not consider how vital the roles of environment and social setting play on behavior. According to psychologist Albert Bandura, people are influenced by the interaction between their environment and intrinsic beliefs (7). The mistake the LiVe Vending Machine makes is that it targets the audience at the individual level within specific environments. Within the confines of a school setting or mall, it is up to the individual to approach the machine and interact with it. Then, it is up to the individual to decide whether they think that they ought to make a change to their lifestyle. The Social Learning Theory is based on the belief that people do not learn behaviors individually, but rather, from their social environment (7). The intervention would have been successful if it had targeted the involvement of a group of youths. Additionally, the messages that the vending machines try to convey are constricted to those particular environments. Although the vending machine is set up in school settings and shopping malls, it does not have the ability to impact the individual in the home. Even if youths were to consider change, the intervention does not encourage the member of the household who has the purchasing power (usually the mother) to purchase better foods. Thus, the intervention fails because it does not take a holistic approach to changing the social norms within groups. What the intervention really lacks is a youth-inspired brand to motivate youths to actively make a change together. Youths who are not included within an intervention will not feel empowered to get involved; however, if a youth is involved and feels invested in a cause, they are more likely to maintain their health beliefs and include their peers. As mentioned by Malcolm Gladwell, “ideas and products and messages and behaviors spread just like viruses do” (16). When an idea gathers a large enough following, it experiences a tipping point. After the tipping point, the idea becomes a social norm. The intervention fails to make healthy thinking a social norm among youths.  
In addition to the intervention’s focus on the individual, another feature that is overlooked is the method by which the individual receives the message. The intervention does not consider that teenagers are informed in multiple settings that junk food is bad for them. Just as teenagers may not listen or relate to their parents, so too is it difficult for a teenager to relate to a machine. Although the machine jokes that, “if you continue to eat those things, you won’t be able to move, just like me!” it does not have the same effect as if a human being had delivered the message (3). Health advocacy needs to come from an appropriate source. Just because the intervention attempts to take the perspective of a teen by appealing to their sense of humor does not mean that the teenagers will take it to heart. By nature, the messages would have a greater impact if they were delivered by a peer or respected other. Youths need to believe that the message is perceived as cool among their friends; however, the only real message that a youth receives is one that they receive from multiple other sources. A vending machine cannot deliver an effective message alone without youth advocacy. 
Proposed Intervention
            In order to increase effectiveness of the intervention, the intervention must accomplish three things. 1) It must involve the target audience with a “show, not tell” mindset. 2) It must encourage healthy habits through positive messages that inspire the target audience. 3) It must brand healthy eating as something that is “cool” and “empowering” that the target audience will want to be a part of. To accomplish the first task, the intervention must be proactive. Where the original LiVe Vending Machine only offered advice and neither took money nor gave out snacks, the new machine will offer healthy alternatives to those snacks. One of the barriers to establishing healthy habits is the misconception that healthier food is not as tasty as junk food. The intervention must disprove that. The alternative snacks will be based on their qualities (sweet, sour, salty, etc). For example, when someone requests a strawberry candy, they may get fresh strawberries. This way, students can interact more with the machine and even have the machine change their perception of how healthy snacks can satisfy the same cravings as unhealthy snacks. This method is more empowering than the Health Belief Model and gives youths a feeling of control in their decision-making. Secondly, the machine will deliver positive messages to its consumers. Where the original LiVe Vending Machine criticizes unhealthy foods and (by extension) its consumers, the new machine will promote healthy foods. Instead of suggesting how the food will hurt your body, the machines will give compliments to the consumer on how the healthy food choice will help the student look and feel better. Doing so will eliminate the possibility of social reactance and negative labeling because youths will not feel that they are being criticized. Lastly, the intervention will make healthy eating a social norm by creating a brand that youths will want to be a part of. To do so, the intervention will involve students throughout the school to take a hands-on approach to a healthy lifestyle. Students will be able to visit farmers markets and select healthy food options for the vending machine, go to classrooms to demonstrate cool foods, and run events that encourage other students to get active. By making healthy choices something that is social, interactive, and fun, students are more likely to consider the choices that they make when it comes to their health. Additionally, expanding youth exposure to include their local community is more likely to help youths consider their health in a broader setting than just a school or mall setting.  
Defense of Intervention 1 – Be Proactive
            Without the witty messages produced by the LiVe Vending Machine when the audience presses its buttons, the machine is nothing more than another attempt at informing the public that unhealthy food is unhealthy. In order to be effective, the intervention must be capable of generating change within its target audience. This would be done best through demonstrations that engage youths. Instead of relying on the Health Belief Model that youths will change their habits just because they are informed that junk food is bad, the intervention needs to surprise youths. The new LiVe Vending Machine must challenge the common perception that healthy food is not as tasty as unhealthy good (13). To do so, the new machine will actually allow youths the opportunity to sample and assess for themselves whether they would like to make a change to their diet. Where the old machine joked about unhealthy foods, the new machine takes a proactive approach that demonstrates to its audience how healthy food can make you feel better.
If LiVe Vending Machines really wanted to change the way people looked at nutrition, it would involve more audience participation. Instead of talking at the audience, the new machine will take a different approach by offering truly healthy alternatives. As a customer picks a snack, the machine could offer a healthy choice to satisfy the same craving that the unhealthy choice would have satisfied. Alternative choices would come in categories like sweet, savory, tangy, salty, sour, or spicy. For example, if someone wanted to pick some sugary gummies from the machine, the machine would offer a small assortment of fresh fruit instead because it acknowledges that the person’s body is actually craving something sweet (9). If someone chose some potato chips, the machine would offer a healthy choice chip with unrefined sea salt. When someone craves chocolate, what their body actually needs are raw nuts and legumes, so alternatively, if someone wanted chocolate, the machine would offer dark chocolate covered nuts (9). Through demonstrating how healthy alternatives can satisfy cravings just as well as unhealthy choices, consumers are far more likely to consider adopting healthy choice snacks. 
Defense of Intervention 2 – Focus on Messages & Values that Matter
The main reason young audiences are quick to dismiss messages concerning health is that they do not value health. The intervention would have been more effective if it had performed extensive research into why school age children do choose unhealthy options from vending machines instead of assuming that school age children needed to know why they should not choose unhealthy options from vending machines. The truth is that junk food is delicious, cheap, and readily available. Instead of messages that look poorly on junk food, messages would have a greater impact if they looked highly on alternative healthy foods. Where consumers feel that authorities are condemning their food choices, consumers are more likely to react negatively and continue making poor choices. Conversely, positive messages are likely to reinforce healthy choices among consumers. Positive messages are also more likely to continue to motivate youths to make healthy choices over time.  
In order to better deliver messages to youths, the intervention would have to appeal to core values that youths can relate to. The new vending machines will deliver positive messages that value making a difference, being important, and taking control. For example, a message could say, “This fruit can improve your complexion” instead of “these potato chips were soaked in grease” or “This vegetable can give you more strength for your sports tournament” instead of “you could use a run.” This intervention avoids the problems that the LiVe Vending Machine had with social reactance. Instead of patronizing youths when they make poor choices, the new machine empowers youths when they make the right choices. Target audiences will not feel shamed for choosing junk food because the machine will not address junk food.  
Defense of Intervention 3 – Make Nutrition a Social Norm
According to the social marketing theory, change is a product of the individual and the environment (13). In order to effectively produce change, the intervention must impact the target population at the group level and influence the surrounding environment. Where the old LiVe Vending Machine focused changing individual’s perception of junk food, the new vending machine intervention will consider the changing social norms within the population. In effect, the new Live Vending Machine will create a brand that encourages youths to get involved. The goal is that by creating a brand for healthy eating, youths will feel empowered to make a positive change. By incorporating youth membership and activity within the intervention, youths will see this as an opportunity to be a part of something with their peers. The results of the intervention are more likely to be maintained if youths feel a sense of membership and ownership over the movement.
The new LiVe Vending Machine intervention will take a holistic and hands-on approach to healthy eating. A shortcoming of the original LiVe Vending Machine was that even though it was set up in popular places for youths to hang out, it was not incorporated into their daily lives any more than another advertisement. To address this, the program will encourage students to go out in the community in search of healthy food options to stock the vending machine. This accomplishes two things. First, it gives youths responsibility and choice. Second, it exposes youths to sources where they can find fresh produce. By encouraging participation, students will feel like they have control over their choices. In addition to stocking the vending machine, the intervention will include classroom demonstrations on how to prepare easy, nutritious and delicious snacks. Again, the intervention will incorporate samples to change the misconception that healthy food cannot be satisfying. Lastly, the intervention will include events that involve group physical activity. Not only does this foster good fellowship among students, but it also makes exercise fun within a social environment.

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