Leadership Development in Dental Education: Report on the ADEA Leadership Institute, 2000-14.

The American Dental Education Association's Leadership Institute (ADEA LI) is the association's flagship development program for those aspiring to leadership in dental and higher education. As with previous studies of the ADEA LI, ADEA will use information from the survey described in this report to improve the ADEA LI curriculum and to guide other leadership development efforts. In 2014-15, ADEA distributed a 50-item online survey via email to all ADEA LI alumni from the classes of 2000 through 2014. The survey included selected-response questions, closed-ended questions, and open-response questions. The survey had an overall response rate of 47% (133/285); response rates to individual items varied. The mean age of the respondents when they participated in the Institute was 48.5 years. Men and women were almost equally represented among the respondents. Nearly half reported their ultimate career goal as department chair, associate dean, or assistant dean, while 20 (15.8%) indicated a goal of becoming dean and 15 (11.8%) aspired to administrative roles higher than dean. Areas the respondents recommended for improvement included more programming in budgeting and financial management, fundraising, and personnel management. Almost 100% of the respondents indicated they would recommend the ADEA LI to others. Overall, the survey respondents confirmed the value of the ADEA LI in their assessment of their fellowship and its subsequent application to their careers. Comparison of elements from this study to previous studies of ADEA LI alumni demonstrates the effectiveness of past changes made to the Institute and the creation of additional ADEA leadership initiatives.

A Profile of Dental School Deans, 2014.

To develop a profile of current U.S. dental school deans and report their perceptions, challenges, and opportunities that should be addressed in the leadership development programs of the American Dental Education Association (ADEA), data were gathered using a web-based survey organized into seven content areas. In 2014, the deans of all accredited dental schools in the U.S. including Puerto Rico were invited to participate in the survey. The response rate was 86% (56/65). A majority of the deans were male (N=44; 79%) and white/non-Hispanic (N=49; 88%); all reporting degrees held a DDS/DMD (N=54; 100%). Just over half were between the ages of 46 and 55 (N=31; 55%) when they first became a dean. The mean age of these deans was 61.4 years, with a range of 48-72. The respondents reported that school administration/management, fundraising, students, the academic environment, leadership development, and faculty had a high level of influence on their job satisfaction. Communication, conflict resolution, and finance were reported as the most important knowledge areas. A majority reported being better prepared for clinical education and student relations than fundraising and research when they took their positions. They responded that finances and faculty recruitment and retention were their greatest challenges as a dean. Among these respondents, 98% (N=55) reported being satisfied to very satisfied with their job overall. The survey results will inform ADEA's leadership development programs for the next five to seven years.

Attitudes and preferences of parents about being present in the dental operatory.

PURPOSE: To determine if there was an association between the type of dental procedure being performed on children and parental desire to be present in the operatory. METHODS: Parents (N=339) whose children had dental appointments at a university pediatric dental clinic or affiliated practices in Southern Nevada completed a survey. Parents identified attitudes/preferences associated with five commonly conducted pediatric dental procedural scenarios. Data were analyzed using chi-square tests (P=.05). RESULTS: Most respondents (N=339) were female (N=248) and/or Hispanic (N=204), had a household income of less than $50,000 annually (N=251), and a high school education. The primary reason (78 percent) parents wanted to be present during their child's dental treatment was comfort. Most parents wanted to observe exams/X-rays (70 percent), sedation procedures (69 percent), fillings and crowns (66 percent), extractions (64 percent), and physical restraint (61 percent). Only 38 percent of parents would be content with the dentist unilaterally deciding about their presence in the operatory. CONCLUSIONS: Parents in this study expressed a preference to remain with their child during any dental treatment. Practitioners are encouraged to consider their presence customary and establish office policies and protocols that beneficially involve parents in the pediatric patient's care.

Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial.

BACKGROUND: Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. OBJECTIVE: To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. DESIGN: A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. PARTICIPANTS/SETTING: From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. MAIN OUTCOME MEASURES: A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans-fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. STATISTICAL ANALYSES PERFORMED: Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ² tests compared percent meeting fat-related and food group recommendations at 12 months. RESULTS: At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. CONCLUSIONS: The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality.

Evaluation of an integrative model for professional development and research in a dental curriculum.

The purpose of this project was to evaluate a Research, Professional Development, and Critical Thinking Integrative Model developed for use in a dental curriculum. This article outlines strategies used in developing a competency-based pedagogical model designed to provide a tailored student learning environment with objective, measurable, and calibrated assessment outcomes. The theoretical model integrated elements of critical thinking, professionalism, and evidence-based dentistry across dental school disciplines; implementation was based on consensus of dental faculty and student representatives about course content, faculty allocation, and curriculum alignment. Changes introduced included the following: 1) conversion and integration of previously siloed course content taught in Years 1 and 2 to sequential two-year combined courses; 2) reduction of course and content redundancies; 3) delivery of courses by teams of faculty members in biomedical, behavioral, and clinical sciences; and 4) reduction of total curriculum credit/contact hours from 13.5 (201 contact hours) to 5.0 (60 contact hours), allowing the Curriculum Committee to accommodate additional courses. These changes resulted in improvement in student satisfaction.

Interprofessional faculty development: integration of oral health into the geriatric diabetes curriculum, from theory to practice.

BACKGROUND: Health care workforce shortages and an increase demand for health care services by an older demographic challenged by oral-systemic conditions are being recognized across health care systems. Demands are placed on health care professionals to render coordinated delivery of services. Management of oral-systemic conditions requires a trained health care workforce to render interprofessional patient-centered and coordinated delivery of health care services. The purpose of this investigation was to evaluate the effectiveness of an interprofessional health care faculty training program. METHODS: A statewide comprehensive type 2 diabetes training program was developed and offered to multidisciplinary health care faculty using innovative educational methods. Video-recorded clinically simulated patient encounters concentrated on the oral-systemic interactions between type 2 diabetes and comorbidities. Post-encounter instructors facilitated debriefing focused on preconceptions, self-assessment, and peer discussions, to develop a joint interprofessional care plan. Furthermore, the health care faculty explored nonhierarchical opportunities to bridge common health care themes and concepts, as well as opportunities to translate information into classroom instruction and patient care. RESULTS: Thirty-six health care faculty from six disciplines completed the pre-research and post-research assessment survey to evaluate attitudes, knowledge, and perceptions following the interprofessional health care faculty training program. Post-training interprofessional team building knowledge improved significantly. The health care faculty post-training attitude scores improved significantly, with heightened awareness of the unique oral-systemic care needs of older adults with type 2 diabetes, supporting an interprofessional team approach to care management. In addition, the health care faculty viewed communication across disciplines as being essential and interprofessional training as being vital to the core curriculum of each discipline. Significant improvement occurred in the perception survey items for team accountability and use of uniform terminology to bridge communication gaps. CONCLUSION: Attitude, knowledge, and perceptions of health care faculty regarding interprofessional team building and the team approach to management of the oral-systemic manifestations of chronic disease in older adults was improved. Uniform language to promote communication across health professionals, care settings, and caregivers/patients, was noted. Interprofessional team building/care planning should be integrated in core curricula.

Position of the Academy of Nutrition and Dietetics: oral health and nutrition.

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Dietary guidance for people wearing removable prostheses.

BACKGROUND: The authors identified and described dietary strategies appropriate for dental patients who receive dental care that includes the placement and maintenance of dental prostheses. CONCLUSIONS: Identification of a patient's perception of food choices associated with placement of a dental prosthesis can lead to delivery of patient-focused dietary guidance for the promotion of targeted food choices to improve oral health and systemic health. An interview guide for assessment of patient satisfaction and a guide for suggested dietary choices and modifications are provided. CLINICAL IMPLICATIONS: Dental professionals can tailor food modification strategies and promote healthful food choices, enhance patient satisfaction and improve health outcomes.

The effect of tobacco and marijuana use on dental health status in Nevada adolescents: a trend analysis.

PURPOSE: Tobacco use is the leading cause of preventable death worldwide. If current trends persist, tobacco will kill more than 8 million people worldwide by 2030 and 1 billion by the end of the century. The purpose of this study was to determine trends in tobacco/marijuana use in Nevada adolescents and their effect on dental health status. Relative comparative data were compared with nationally reported data. METHODS: Retrospective data in this cohort study was from an ongoing statewide, school-based, dental health screening initiative that was conducted across 8 years (2002-2010) in public/private middle/high schools in Nevada. A total of 66,941 dental health screenings of adolescents between ages 13-18 were conducted. Self-reported data were collected on tobacco/marijuana use. Descriptive statistics and trends were reported. Means (SE) were computed for caries prevalence and severity. Effect size was reported on dental caries and use of tobacco/marijuana. RESULTS: Overall, percentage prevalence of tobacco use was approximately the same as the national average; however, there were significantly higher rates of marijuana use (12.0% vs. 3.3%). Prevalence and severity of dental caries was significantly higher in those who used tobacco/marijuana than those who did not across all variables and across all 8 years controlling for gender, race/ethnicity, where they lived, and exposure to secondhand smoke. CONCLUSIONS: Tobacco use negatively affected dental health status with marijuana having the largest negative effect. The findings from this study identified the need for tobacco/marijuana prevention services targeting adolescents residing in the geographic areas most at risk.

HEALTHY study school food service revenue and expense report.

BACKGROUND: Food service directors have a concern that federal reimbursement is not meeting the demands of increasing costs of healthier meals. The purpose of this article is to report the food option changes and the annual revenues and expenses of the school food service environment. METHODS: The HEALTHY study was a 3-year (2006 to 2009) randomized, cluster-designed trial conducted in 42 middle schools at 7 field centers. The schools selected had at least 50% of students who were eligible for free or reduced-price lunch or who belonged to a minority group. A randomly assigned half of the HEALTHY schools received a school health intervention program consisting of 4 integrated components: nutrition, physical activity, behavioral knowledge and skills, and social marketing. The nutrition component consisted of changing the meal plans to meet 5 nutrition goals. Revenue and expense data were collected from income statements, federal meal records, à la carte sale sheets, school store sale sheets, donated money/food records, and vending machines. RESULTS: Although more intervention schools reached the nutritional goals than control schools, revenues and expenses were not significantly different between groups. CONCLUSION: The HEALTHY study showed no adverse effect of school food policies on food service finances.

Electronic vs. traditional textbook use: dental students' perceptions and study habits.

This descriptive study assessed dental students' attitudes about computer use as it relates to study habits and use of e-textbook technology. Academic deans and student leaders at all accredited dental education programs in the United States, Puerto Rico, and Canada were asked to forward an e-mail to students explaining the purpose of the study and asking them to participate. The e-mail included an embedded URL link to the survey. A total of 703 complete responses from twenty-four dental schools were received and used in the final analysis. Because the number of students contacted could not be determined, the overall response rate cannot be calculated. Over 65 percent of the respondents reported spending >11 hours per week studying although over 75 percent said they spent little time studying from their textbooks. Over 55 percent were from schools that use e-textbooks exclusively, with 25 percent from schools that exclusively use print textbooks. One-fourth indicated they purchased a traditional printed textbook even when an e-textbook was provided; more than one-third printed information from the e-textbooks rather than reading on the computer. A majority (59 percent) preferred traditional textbook resources over e-textbooks, with over 50 percent reporting not using the required e-textbooks at all. E-textbooks were used by students in this study less frequently than materials/notes provided by dental school faculty. The majority preferred to use traditional resources as references and for augmenting lecture material.

Effect of nutrition changes on foods selected by students in a middle school-based diabetes prevention intervention program: the HEALTHY experience.

BACKGROUND: The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. METHODS: The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. RESULTS: Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high-fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added-sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. CONCLUSION: The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.

Improving quality of Food Frequency Questionnaire response in low-income Mexican American children.

The authors evaluated the validity and reliability of the Block Kids Food Frequency Questionnaire (BKFFQ) and the Block Kid Screener (BKScreener) in Mexican American children living along the Texas-Mexico border who participated in the National Institutes of Health-funded Proyecto Bienestar Laredo. The Bienestar/NEEMA health program is a school-based diabetes and obesity control program, and the Proyecto Bienestar Laredo is the translation of the Bienestar/NEEMA health program to 38 elementary schools in Laredo, Texas. Par ticipants included 2,376 eight-year-old boys (48%) and girls (52%) from two school districts in Laredo. Two Food Frequency Questionnaire (BKFFQ and BKScreener) dietary intakes were collected, and an expert panel of nutritionist assigned a classification response quality of "Good," "Questionable," and "Poor," based on playfulness (systematic or nonrandom) patterns and completion rates. In addition, both instruments were assessed for reliability (test-retest) in 138 students from a San Antonio School District. Children's height, weight, percentage body fat, reported family history of diabetes, and Texas Assessments of Knowledge and Skills in reading and mathematics scores were collected. This study showed that for Mexican American children living along the Texas-Mexico border, within the time constraints of the classroom, BKScreener yielded better data than the BKFFQ.

Southern Nevada assisted living residents' perception of their oral health status and access to dental care.

OBJECTIVE: Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\s to dental care by Southern Nevada Assisted Living Facilities Residents. METHODS: A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square. RESULTS: Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor. CONCLUSIONS: Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored.

Ninth-grade students' perceived attitudes and behaviors in a tobacco cessation program delivered by dental educators.

This study measured whether a tobacco cessation program in Nevada's Clark County School District (CCSD) delivered by dental educators affected ninth-grade students' short-term perceived knowledge, attitudes, behaviors, and intentions (KABI) toward tobacco use and whether the CCSD's immersion approach led to positive changes in students' KABI. A quantitative research methodology with a descriptive research design was used. Data were collected from 617 students using pre- and post-program surveys self-administered by the participants. The surveys were based on those used previously in national and other large-scale epidemiologic studies assessing tobacco intervention program effectiveness. The survey data revealed that, after the program, more students had an increased awareness of tobacco use dangers to their health and significantly increased awareness of the negative consequences of tobacco use. The number of students who did or did not use tobacco changed very little as a result of the program, but the tobacco users on the post-program survey did report statistically significant decreases in overall use. Significant reduction in tobacco usage by the tobacco users indicates some desire on the part of smoking students to quit or reduce their tobacco usage. Little evidence of major changes in student attitudes was found.

Validation of a multifactorial risk factor model used for predicting future caries risk with Nevada adolescents.

BACKGROUND: The objective of this study was to measure the validity and reliability of a multifactorial Risk Factor Model developed for use in predicting future caries risk in Nevada adolescents in a public health setting. METHODS: This study examined retrospective data from an oral health surveillance initiative that screened over 51,000 students 13-18 years of age, attending public/private schools in Nevada across six academic years (2002/2003-2007/2008). The Risk Factor Model included ten demographic variables: exposure to fluoridation in the municipal water supply, environmental smoke exposure, race, age, locale (metropolitan vs. rural), tobacco use, Body Mass Index, insurance status, sex, and sealant application. Multiple regression was used in a previous study to establish which significantly contributed to caries risk. Follow-up logistic regression ascertained the weight of contribution and odds ratios of the ten variables. Researchers in this study computed sensitivity, specificity, positive predictive value (PVP), negative predictive value (PVN), and prevalence across all six years of screening to assess the validity of the Risk Factor Model. RESULTS: Subjects' overall mean caries prevalence across all six years was 66%. Average sensitivity across all six years was 79%; average specificity was 81%; average PVP was 89% and average PVN was 67%. CONCLUSIONS: Overall, the Risk Factor Model provided a relatively constant, valid measure of caries that could be used in conjunction with a comprehensive risk assessment in population-based screenings by school nurses/nurse practitioners, health educators, and physicians to guide them in assessing potential future caries risk for use in prevention and referral practices.

Inequalities of caries experience in Nevada youth expressed by DMFT index vs. Significant Caries Index (SiC) over time.

BACKGROUND: With the increasingly polarized distribution of dental caries among children and adolescents, the usual DMFT measure has become a less meaningful population descriptor. To re-focus on identifying the high caries prevalence group the Significant Caries Index (SiC) was created. The aims of this study were to analyze the prevalence and severity of dental caries in Nevada youth over a period of eight years and to compare its expression by means of DMFT and SiC; analyze the caries trends in the population and their underlying factors, and determine whether Nevada youth were at risk for significantly high levels of dental caries. METHODS: Retrospective data was analyzed from a series of sequential, standardized oral health surveys across eight years (2001/2002-2008/2009) that included over 62,000 examinations of adolescents 13-19 years of age, attending public/private Nevada schools. Mean Decayed-Missing-Filled Teeth index (DMFT) and Significant Caries Index (SiC) were subsequently computed for each academic year. Descriptive statistics were reported for analysis of comparative DMFT and SiC scores in relation to age, gender, racial background, and residence in a fluoridated/non-fluoridated community. Logistic regression analysis was used to analyze the differential impact of the variables on the probability of being in the high caries prevalence group. RESULTS: Comparison of students' mean DMFT to National (NHANES) data confirmed that dental caries remains a common chronic disease among Nevada youth, presenting higher prevalence rates and greater mean scores than the national averages. Downward trends were found across all demographics compared between survey years 1 and 6 with the exception of survey year 3. An upward trend began in survey year six. Over time, the younger group displayed an increasing proportion of caries free individuals while a decreasing proportion was found among older examinees. As expected, the mean SiC score was significantly higher than DMFT scores within each survey year across comparison groups (p < 0.001). CONCLUSIONS: Using both caries indices together may help to highlight oral health inequalities more accurately among different population groups within the community in order to identify the need for special preventive oral health interventions in adolescent Nevadans. At the community level, action should focus on retaining and expanding the community fluoridation program as an effective preventive measure. At the individual level the study identifies the need for more targeted efforts to reach children early with a focus on females, Hispanics and Blacks, and uninsured children.

The effects of the HEALTHY study intervention on middle school student dietary intakes.

BACKGROUND: The HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups). METHODS: HEALTHY was a cluster-randomized study in 42 public middle schools. Students, n=3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools. RESULTS: The reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p=0.0016). The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p=0.008). There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption. CONCLUSION: The HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to student's reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children.

Impact of the HEALTHY Study on Vending Machine Offerings in Middle Schools.

PURPOSEOBJECTIVES: The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. METHODS: Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. RESULTS: At baseline, 15 intervention and 15 control schools had beverage and/or snack vending machines, compared with 11 intervention and 11 control schools at the end of the study. At the end of study, all of the intervention schools with beverage vending machines, but only one out of the nine control schools, met the beverage goal. The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines. APPLICATIONS TO CHILD NUTRITION PROFESSIONALS: The HEALTHY study's vending machine beverage and snack goals were successfully achieved in intervention schools, reducing access to less healthy food items outside the school meals program. Although the effect of these changes on student diet, energy balance and growth is unknown, these results suggest that healthier options for snacks can successfully be offered in school vending machines.