State Regulations to Support Children’s Cultural and Religious Food Preferences in Early Care and Education

Our review of the ECE regulations revealed that most states did not have regulations consistent with the benchmark to incorporate the cultural and religious food preferences of children into meal planning. There were, however, some states (Hawaii, Mississippi, and Nevada) that had regulations that fully met the benchmark for both centers and homes. Generally, we observed stronger regulations for centers compared to homes. This finding is consistent with previous reviews examining the presence and strength of state regulations for ECE related to infant feeding (Benjamin et al. 2009) and breastfeeding (Gonzalez-Nahm et al. 2017). Overall, centers tend to be regulated more often and more stringently than homes. Few states, however, had regulations that required centers or homes to fully consider the cultural and religious preferences of children in their meal planning. The results of this review, however, may serve as a baseline to assess future changes in state regulations and consistency with the 2018 benchmark, especially as ECE programs become greater targets for the promotion of culturally and religiously appropriate foods.

Though there has been growing national attention to strengthening the ECE systems to support healthy child development, more can be done to appropriately support culturally and religiously appropriate foods in these settings. Food practices are frequently steeped in cultural tradition; oftentimes meals are incorporated into ceremonies and are used as a marker to help define a social group or identity (Block et al. 2011). The many heterogenous American Indian/Native Alaskan (AI/NA) and immigrant populations provide powerful examples to consider in dialogues around access to cultural and religious foods. Reinforcing traditional foods and cultural practices is a promising approach to address the disproportionately high rates of diabetes experienced by many AI/NA groups (Satterfield et al. 2016). Some research suggests that the nutrition transition that AI/NA populations experienced over the course of history is partially responsible (Story et al. 1998; Welty, 1991). A prior study also found that the Westernization of native diets can affect markers of cardiovascular health (Bersamin et al. 2008). However, culturally-tailored interventions can help improve dietary habits and manage chronic disease in diverse populations (Juarez-Ramirez et al. 2019; Seguin et al. 2019; Story et al. 1999). Similarly, the epidemiological paradox exists, where newcomers to the US tend to arrive in better health and have better health outcomes than their US-born children or grandchildren. This “healthy immigrant effect” is complicated, but one component is thought to be the cultural change in diet and dietary intake (Gushulak, 2007). As a part of this comprehensive approach, it is important to consider the barriers and opportunities that govern ECE environments, including the foods served to children.

Many children in the US are growing up in heterogenous, multicultural communities with cultural and religious blending. Recognizing this, we argue that state-level policy like an ECE regulation is still useful grounds for discussion and support of culturally and religiously appropriate ECE. Policy-based interventions have the potential to improve healthy eating in ECE and may be more sustainable than other types of behavioral interventions (Larson et al. 2011; Lessard and Breck, 2015). Moreover, a recent study highlighted the need for culturally sensitive policies within ECE (Messiah et al. 2017). There is also evidence that states use the benchmarks in drafting their regulations. Mississippi, for example, explicitly based its nutrition regulations for both centers and homes on the benchmarks in Miss. Admin. Code 15-11-55. Other states may consider incorporating the cultural foods benchmarks in future revisions or updates to regulations.

This study has limitations. Cross-sectional reviews do not address actual practices within ECE programs. Despite this, policy-based approaches to promoting healthy eating in ECE are becoming more common in the US (Neelon and Briley, 2011; Larson et al. 2011; Van Stan et al. 2013). Previous cross-sectional studies have documented nutrition-related regulations targeting ECE and found wide variation among states (Benjamin et al. 2008; Kim et al. 2012). However, a few studies have evaluated regulations and assessed provider practices or child health outcomes. One prior study quantified the potential health impact of a multicomponent regulatory intervention for ECE and found that regulatory changes could lead to decreased screen time, increased physical activity, and lower sugar-sweetened beverage consumption in children in care (Wright et al. 2015). In another prior study, researchers evaluated compliance with nutrition regulations in New York City (Lessard et al. 2014). They found that greater than 80% of ECE centers complied with the regulations governing milk, juice, and sugar-sweetened beverages. Additionally, about 50% complied with the juice and water regulations. However, the researchers evaluated compliance with the regulation after it was enacted and did not collect baseline data prior to the implementation of the regulation. Another previous study prospectively assessed compliance with new healthy eating regulations in a single state and found some improvement in alignment with the nutrition standard after the policy took effect (Neelon et al. 2016). Researchers evaluated 13 nutrition standards governing ECE centers serving low-income children in South Carolina and used North Carolina, a state not making policy changes, as the comparison (Neelon et al. 2016). They found that the new standards modestly improved nutrition practices in South Carolina centers post-policy. Thus, although there is evidence that state regulations have the potential to impact nutrition practices, more information is needed to demonstrate the effectiveness of new or enhanced regulations in a variety of ECE settings and states.

Early care and education programs could also incorporate the cultural and religious preferences of children into meal planning without being prompted by regulation, and this review would not capture these practices. However, there is no specific funding mechanism for states or for ECE programs to encourage implementation of the standards. The standards are also not disseminated directly to states or programs. Despite this, ECE programs may still be engaging in meal planning that aligns with the standard. Another limitation is that this study did not include Tribal laws or local jurisdictional ECE licensing laws. Tribal licensing laws and local licensing laws were outside the scope of our analysis, although these laws also merit examination as many Tribes have laws regulating child care programs within their jurisdictions. Additionally, this review is current through June 2018 and states may have already updated their regulations. Researchers interested in monitoring and evaluating ECE regulations should consider conducting these reviews regularly to assess change over time.