HOVER FAQ’s for health professionals

What is HOVER?
HOVER is an acronym for 'Healthier Options in Vending - an Employer Resource'.
HOVER was a research project that is investigating the availability of healthier food options in Tasmanian workplaces. The project aimed to educate employers about the importance of supplying healthier food options to their employees, and the benefits of this approach. In its initial phase, the project specifically targets the food options available in workplace vending machines.
The project involved a series of consultations with vending machine suppliers, the food industry, employers and employees. This has resulted in a number resources being developed to assist employers in switching to healthier food options in their workplace vending machines.

How was HOVER initiated?
HOVER is a partnership initiative of Eat Well Tasmania, in conjunction with the Community Nutrition Unit, Population Health, DHHS.

How is HOVER funded?
Phase 1 of the project (July 2009 – June 2010) was funded by Population Health, Department of Health and Human Services.
Phase II of the project (July 2010 – November 2011) was funded through Healthy@Work, Department of Premier and Cabinet.
What is the goal of the HOVER project?
To ensure that where workplaces have vending machines, a range of clearly identified healthy food and drink choices are provided and promoted.
What are the Key Focus Areas of the HOVER project?
Increased capacity to drive change in workplace nutrition through healthier vending.
Increased understanding of barriers and enablers to implementing healthier options in vending in Tasmanian workplaces.
Increased capacity for vending machine suppliers and workplaces to implement healthier vending options.

Why is it called ‘healthier’ options in vending rather than ‘healthy’?
Due to the need for shelf stability, the majority of products suitable for vending are highly processed. Processing usually leads to increases in sugar, fat and sodium content of the product, and often reduces the fruit and vegetable content. However, many of these products are still clearly healthier than traditional vending products, such as chocolate bars, deep fried chips and soft drinks. Therefore, vending products are described as ‘healthier’ rather than ‘healthy’.

How was the set of nutrient criteria developed?
Other jurisdictions around Australia had implemented strategies/policies in health facilities requiring that healthier options were available in all food outlets, including vending machines.  FSANZ and Auckland District Health services also had nutrient profile systems. These strategies were examined in detail to determine whether an existing model could be adopted for the purpose of this project.  Key informants from each jurisdiction were identified and interviewed to ascertain challenges and successes with the implementation of criteria interstate and overseas.
In determining a set of criteria that were appropriate for Tasmania, input was sought from a wide group of health professionals, including accredited practising dietitians and a range of peak health bodies, such as Oral Health, the Cancer Council and the Heart Foundation.

What model was adopted?
The decision was made to base the criteria on the NSW model as it is the easiest to use and the most realistic in terms of implementation, i.e. allowed for 20% red in vending machines, did not have a kJ/100g and per serve for snack foods.  It has the least number of food categories, less nutrient criteria and is not as strict as others, therefore easier to adopt in the current food supply system.

Why use a traffic light model?
The traffic light model is easily understood and interpreted by the vast majority of adults. Five other jurisdictions in Australia have adopted the traffic light model for their healthy options in workplace facility strategies.
In addition, the National Healthy School Canteen Guidelines (NHSCG) have adopted the traffic light model, and the Tasmanian CoolCAP is likely to adopt the NHSCG.
The food industry is already familiar with the traffic light model, making it easier to engage them in this model.

Why did HOVER decide to adopt a model from elsewhere?
Tasmania wanted a simple strategy to increase the likelihood of implementation.
It was determined that there was not the capacity to develop new criteria within the scope of the HOVER project.
Nutrient criteria are a tool for engaging with workplaces and industry: it was deemed important not to focus too much on criteria at the expense of engaging with workplaces and industry.
In addition, NSW and NHSCG have modelled their criteria on existing criteria and modified it to ensure it is achievable and simple. The criteria have been tried and tested and shown to be relatively effective.

Why does the HOVER resource suggest that workplace vending machines allocate space to red/sometimes foods?
Consultations with other jurisdictions indicated that prohibiting red products resulted in an outcry from staff and the public and in some cases even resulted in unions and politicians being involved.  For this reason alone, it was recommended that a more moderate and balanced approach would likely be more successful in Tasmania. 
Consultations also indicated that due to the very limited availability of healthier alternatives in the current market for vending machines, it was necessary to recommend a more moderate ratio of red: amber: green products.  In the future as the vending industry changes, there may be opportunity to tilt this ratio even further in favour of healthier options. 
This recommendation favours healthier alternatives, and guidelines were also made around the physical set up of the vending machine to further favour green products. 
It is important to also note that these are just recommendations—depending on the motivation and energy of the workplace and their supplier there is scope for inclusion of all green/amber products. Equally, if supply of amber and green products is limited, then a workplace can start with a greater percentage of red products, changing the ratio over time to favour healthier products.
Were there some decisions that required greater discussion in creating the HOVER criteria?
Yes, such as the decision to classify all tuna and cracker snacks as amber. Most other jurisdictions required that tuna and crackers needed to be assessed against criteria which deemed many of these products to be red.  Compared with many other vending machine products, tuna and crackers are a healthier alternative. It was felt that categorising these products as red conflicted with the AGTHE and sent confusing messages to consumers, and further limited the number of viable alternative products.
Although some tuna and cracker products could essentially be classified as green (i.e. they contain a low fat low salt dressing and have low fat crackers), many of these products contain added salt and fat in the dressing or crackers. Therefore, for simplicity and consistency, all tuna and crackers snack packs have been classified as amber. 
Full fat cheese and cracker snacks were also classified as amber and reduced fat cheese and cracker snacks were classified as green. As with tuna and cracker snack packs it was felt that cheese and crackers were a healthier alternative for vending machines, and are consistent with the AGTHE. Therefore, the decision was developed to provide a blanket rule for cheese and cracker snack packs and avoid them ever being classified as red. 

How do the HOVER criteria deal with deep fried foods and confectionery?
HOVER classifies all deep fried foods and all confectionery as red, which is consistent with the AGTHE. In some other jurisdictions these products could fit into the amber category by creating a small portion size. It was decided that this would send mixed messages about what is deemed a healthier product.

Where do carbonated water and juice fit into the HOVER criteria?
Carbonated water in serves <=375ml is classified as green, while serves >375ml are classified as amber. Carbonated water has a lower pH than normal water and therefore can contribute to dental erosion.
While juice is currently located in the fruit group of the AGTHE, it was decided that 99% fruit juice in serves <=375ml were to be classified as amber, and serves >375ml to be classified as red. Juices with less than 99% juice are classified as red. The two key reasons for this decision were:
fruit juice contains a considerable amount of sugar and minimal positive nutrition. This sugar contributes to excess and unnecessary kilojoule consumption. 
fruit juice has a low pH and also contains sugar, both of which contribute to enamel erosion and dental caries. 
What about flavoured milk and diet soft drink?
Reduced fat milk in serves <=375ml is classified as green, while full fat milk <=375ml is classified as amber. Reduced fat milk in serves >375ml is classified as amber, while full fat milk in serves > 375ml is classified as red. Flavoured milk contains a considerable amount of added sugar, however unlike soft drink and juice, also contains calcium and protein and is satiating.  Due to these positive aspects, restricted portions of low fat milk are classified as green and full fat restricted portions are classified as amber.
Diet soft drinks in serves <=375ml are classified as amber and serves > 375ml are classified as red. Again this decision was made due to the carbonation and artificial sweeteners found in diet soft drinks and implications for oral health.

How were the criteria for meals developed?
The number-based criteria were taken from the NSW health strategy.  Any meals that met their cut-offs were listed as amber, unless vegetables were included as a prominent ingredient (listed in the name of the product). In these cases, meals were classified as green. These products must list the percentage content of any vegetable listed in the name.

Have there been any problems with the criteria since implementation?
One particular issue has been with the wording of the ready-to-eat mixed meals. To be classified as green, these meals need to meet the number-based nutrient criteria, and also have vegetables listed as a prominent ingredient in the title (see Q16). We have found that this does not necessarily identify a meal that contains a higher vegetable content. This wording will be reviewed in the future.