Introduction
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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