THE LAW REVIEW AT JOHNS HOPKINS
A student-run publication by the Law and International Organizations Society at the Johns Hopkins
School of Advanced International Studies
A Policy Analysis of Current Farm-to-Preschool/ Early Childhood Education Legislation in the United States
by Margaret A. Burns-Rath and Sara E. Benjamin-Neelon Spring 2019
It has been a goal of federal agricultural policy, since the late 1990s, to influence childhood preferences for healthy foods, especially low energy-dense foods such as fruits and vegetables. With a rise in obesity and related chronic diseases, states latched on and introduced legislative policies to connect schools to local farmers, incentivized nutrition programs within the school districts, and provided economic opportunities for local food producers and processors. One such initiative is known as the “Farm-to-School” (F2S) program. Despite the nationwide strides in F2S programs, gaps exist in nutrition intervention opportunities with educational facilities for more than 11 million preschool-aged children in childcare settings. Our knowledge that a child’s dietary behaviors become established well before his/her primary school years and track into adulthood indicates a clear need for a nation-wide effort to broaden the successful F2S model to our younger population. This article suggests developing research to understand associations between current laws and F2P impacts to improve the effectiveness of future legislation. It also recommends enhancing Child and Adult Care Food Program standards and requiring F2P training and nutrition standards for licensure. In the long term, more research is necessary to understand associations between current laws and F2P impacts to improve the effectiveness of future legislation.
Influencing childhood preferences for healthy foods, especially low energy-dense foods such as fruits and vegetables, has been a goal of federal agricultural policy since the late 1990s. With a rise in obesity and related chronic diseases, states latched on and introduced legislative policies to connect schools to local farmers, incentivized nutrition programs within the school districts, and provided economic opportunities for local food producers and processors. One such initiative is known as the “Farm-to-School” (F2S) program.
Despite the nationwide strides in F2S programs, gaps exist in nutrition intervention opportunities with educational facilities for more than 11 million preschool-aged children in childcare settings. Our knowledge that a child’s dietary behaviors become established well before his/her primary school years and track into adulthood indicates a clear need for a nation-wide effort to broaden the successful F2S model to our younger population.
Farm-to-Preschool (F2P) legislation in the U.S. is in its infancy: state legislatures have failed to recognize the importance of supporting, implementing, and funding this successful nutrition education program for our vulnerable youth. Our State Representatives are missing vital opportunities for stemming the rising obesity epidemic and increase in related chronic diseases. This paper discusses the background of the F2P program and the need for its implementation; presents the results of extensive analysis on current state legislation regarding F2P and Farm-to-Early Childhood Education (F2ECE), and provides recommendations for future legislative action.
Obesity and obesity-related chronic diseases have become one of the top public health concerns in the U.S. today. The overall prevalence of childhood obesity has remained unchanged since 2009, with a rate of 16.9% of our youth being obese (1,2). The rate among non-school aged children is providing some optimistic data whereas the obesity rate among low-income 2-5-year-old children declined from 15.9% in 2010 to 14.5% in 2014 (3). Studies indicate that in 70% of cases, overweight children will continue to track this weight gain or become obese as adults (4). The devastating impact of childhood obesity is that for the first time ever, substantial numbers of our children are being diagnosed with adult obesity-related diseases, such as type II diabetes and cardiovascular disease (5,6).
Such problems derive, in part, from a limited understanding of the relationship between dietary patterns and health outcomes in young preschool-aged children (7-11). Indeed, the opportunity to practice healthy eating behaviors early in life may be critical to a child’s weight development and health management (12,13). Taking measures to impact a young child’s willingness to consume healthier options of low energy-dense foods, such as micronutrient-rich fruits and vegetables (F/V), may prepare a child for a life of healthier food choices and prevent obesity and chronic disease (10,14-17).
Fruit and Vegetable Intake to Target Obesity and Disease:
Studies indicate that the lack of F/V intake is associated with hypertension, coronary heart disease, stroke, and certain cancers in adults (14,16,18). Evidence suggests that increased F/V consumption plays a significant role in reducing the burden of disease attributed to cardiovascular disease and cancer, two of the leading causes of mortality worldwide (15,19). Findings from the World Health Organization, Global Burden of Disease study suggest that increasing F/V consumption in individuals could significantly reduce the total burden of disease worldwide, as it was estimated that 1.8% of the total burden of worldwide disease is attributable to inadequate F/V consumption (14).
This public health issue is increasingly recognized at the U.S. federal policy level as costs for medical care rise exponentially every year. As part of the federal efforts, the U.S. Department of Agriculture’s (USDA) 2015-2020 Dietary Guidelines for Americans recommend an increase in F/V consumption in our daily diets (20). The U.S. government’s nationwide policy objectives as drafted in Healthy People 2020, include: (a) increase fruit in the diets of children ages 2 years and older; (b) increase the variety and amounts of vegetables in the diets of children ages 2 years and older; (c) increase the number of states with nutrition standards for foods and beverages to preschool-aged children in childcare; and (d) increase the proportion of school districts that require schools to make fruits and vegetables available whenever food is offered or sold (21).
The U.S. government’s objectives, while encouraging, are an uphill battle. The U.S. Department of Health and Human Services, Center for Disease Control and Prevention (CDC) reviewed F/V intake among children ages 2 – 18 years (22). In their analysis of data from 2003 to 2010, the CDC found that children in the U.S. on average consume less than half of the USDA’s Dietary Guidelines for Americans, 2010 daily recommended number of servings of F/V (22,23). From 2007 to 2010, 60% of children reviewed failed to meet the USDA recommended fruit intake and 93% failed to meet the recommended vegetable intake (22). Between 2009-2010, children ages 2 to 5 years were the only demographic group reviewed that met the Healthy People 2020’s fruit target, yet none met the Healthy People 2020’s vegetable target (22). Instead of the vegetables encouraged by the Dietary Guidelines (i.e. dark green, orange, and red vegetables and legumes), white potatoes accounted for 30% of intake, mostly in the form of French fries or potato chips (22). In a study by Fox, et al., dietary patterns of children aged 2 and 3 years old were reviewed and found 70% consumed vegetables as a distinct food item daily, but that white potatoes were the most commonly consumed vegetable mostly in the form of French fries and other fried potatoes (24). Fewer than 15% of these children ate dark green and deep yellow vegetables, and those that ate other vegetables (commonly corn, broccoli, green beans, mashed potatoes, and mixed vegetables) consumed half the proportion of these compared to fried potatoes (24). Instead of consuming adequate levels of healthier F/V recommended by USDA’s dietary guidelines, U.S. children have diets low in fiber, high in fat and sugar and lacking the necessary nutrients needed for optimum health and growth (25).
Forming the foundation for diets rich in a variety of micronutrient-rich F/V in children is a vital component of obesity and chronic disease prevention efforts, as dietary habits of young children trend into their adolescence and adult years (10,17,26). It is evident as additional research becomes available that instituting interventions that address children’s diets at pre-school age, i.e. from 0-5 years of age, is essential as these early years influence taste and dietary preferences for healthy or unhealthy foods for life (27). Once diet preferences are formed and established early in life, altering these preferences for healthier options, like increasing F/V intake, are difficult to achieve (28).
Feeding children nutritionally balanced diets can be a challenge, as children are born with a biological predisposition to prefer sweet foods and to avoid bitter foods (27). Because flavor is a powerful determinant of behavior, repeatedly exposing infants and young children to healthful foods can help establish food preferences to set the stage for later in life (27). Evidence indicates that repeated and varied opportunities to learn about flavors of healthful foods in infants and young children increase later acceptance of these foods, such as less sweet or bitter F/Vs (27,29-32).  As food fussiness and food neophobia seem to peak between the ages of 2 – 5 years of age, providing repeated taste exposure, as well as educational and sensory experience to a variety of colorful F/V to preschool-aged children can be a valuable tool to influence a child’s future dietary intake (29,30).
The Early Childhood Education Setting:
In the U.S., more than 11 million children under the age of 6 years spend an average of 30 hours per week in non-parental care (33). Sixty-one percent of children between the ages of 3 to 6 years not yet in kindergarten are in center-based care arrangements (34,35). These percentages are even higher (72%) for families that are at twice the poverty level than those at or above the poverty level (34). Childcare facilities include preschools, childcare centers, family child care homes, Head Start, and state-run pre-kindergarten programs within the school districts (33). Because so many of our young children are in non-parental care environments during the day when food exposure is common, providing these children in captive settings with repeated exposure along with age-appropriate educational components regarding healthful foods could be essential to developing long-lasting healthy diets in children (9).
Obesity and chronic disease impact food-insecure families at higher rates, thus programs such as Head Start and state-run pre-kindergarten programs are ideal for targeting nutrition education for low-income children during these crucial years (36-38). Having access to fresh F/V is linked to socio-economic status, where low-income families complain of being able to afford fresh foods to serve their families (39). Low-income children get most of their daily nutrition during the school day, resulting in school meals having a major impact on nutrition exposure (39). Currently, 72% of children aged 3 to 6 years old from food-insecure families spend their days in center-based childcare arrangements, thus early childhood care and education settings have enormous potential for addressing early childhood obesity trends and providing nutrition education.
Recent studies indicate that children attending partial to full-time childcare are more likely to become overweight or obese than those cared for at home by a parent (12,40,41). This is rather troubling evidence, as the objectives of early childhood education settings should be designed to teach and develop a young child’s personal skill sets to prepare them for a stronger future. With such a large percentage of U.S. children in non-parental care, there clearly exists an opportunity to address a gap in nutrition intervention at the childcare setting (42). One of the more recent efforts that could address this gap is through the F2P or F2ECE movement.
History of “Farm-to-Preschool”:
Farm-to-School (F2S) programs began in the late 1990s as a way to promote varied, fresh F/V consumption among school-aged children in the U.S. (43). In 2007, more than 30 organizations grouped together to launch the National Farm to School Network (NFSN) to provide support and leadership in the F2S movement (43,44). The mission of F2S is to connect schools and students to local food producers and processors through the procurement of local foods for use in school meals; educate students about food, nutrition, agriculture, and health; and create edible school gardens for use as experiential learning tools (43,44). Recent data from the NFSN indicated that F2S is operational in all 50 states, serving over 23 million students (44). Introducing local farming and its products to schools was decidedly a successful way to facilitate children’s access to healthy, local foods; empower children to make informed food choices, and strengthen the local economy (44-46).
Increasing recognition of the importance of obesity prevention at the earlier stages in life resulted in the F2P and F2ECE models emerging as natural extensions of the F2S model (44,47,48). In 2011, the Farm to Preschool Subcommittee of the NFSN developed to establish a cohesive network of F2P programs and stakeholders around the U.S. (48,49). The F2P and F2ECE (F2P/ECE) initiative involves the implementation of one or more of three core elements: (1) procurement of local and regional food products; (2) nutrition education, with activities related to local agriculture and food; and (3) school gardens (48,49).
Procurement of Local and Regional Food Products:
The F2S and F2P/ECE core element of introducing locally grown produce to children provides for fresher, and thus better tasting F/V options for snacks and meals (50). By providing fresher and tastier F/V options to children in a child’s physical environment, there is weight to the theory that these children will consume a greater and varied diet of micronutrient-rich F/Vs when provided access (18,50). This is especially important for children that come from food-insecure families that may not have regular access to F/V options in the home (18). Additionally, and an important component for policymakers, it provides for economic development opportunities for communities and local food producers, processors and distributors (45,48,49,51). There is limited data on the full extent of economic benefits for farms and communities (51), however, it is believed that the addition of F2S and F2P/ECE purchasing power for the local food economy provides an alternative market and reliable income stream to producers (45).
Nutrition Education with Activities Related to Local Agriculture and Food:
Early childhood education and F2 education are a natural fit, whereas younger children do especially well in experiential learning environments (52). Activities such as touching, smelling and playing with colorful F/V’s, growing and consuming edible gardens, as well as cooking lessons and taste testing benefit this age-appropriate developmental learning preference. This type of sensory education can increase a child’s willingness to taste and development of preferences for F/V consumption during snack or lunchtime (29,31,43,53-55). These preferences can require 8 - 10 repeated exposures of a novel F/V taste in order to increase acceptance of that F/V (27,28,56). Thus, the F2P/ECE model of having repeated exposure and opportunities for tasting a variety of novel F/Vs instituted within a childcare program is valuable for the development of a child’s dietary patterns, as parents may stop exposure of a novel F/V after only a few rejections by a child.
Longer and often “family style” meal times, as well as the presence of teachers during these times, provides for naturally guided nutrition education and dietary modeling opportunities (43). Additionally, the F2P/ECE setting allows for increased opportunity for parental engagement, as based upon the age of the child participating, and the lack of organized bussing systems that exist for school-aged children, parental support is needed for being dropped off or picked up from care (43). This presents opportunities for additional parental F2P/ECE outreach and education (43). The parental component in the F2P/ECE movement is significant, as generally, parents control what foods are served in the home which has a significant impact on children’s eating habits later in life (57).
School gardens have a long and rich history for engaging children in learning about food sources as well as nature (58). In 1840, Friedrich Froebel coined the German term, “kindergarten”, literally meaning “children’s garden” (kinder meaning children, garten meaning garden) referring to the practice of using gardens to develop preschoolers intelligence through learning about nature (58). Agricultural gardening as a nutrition learning tool for educators engages the child and is a creative avenue to construct interest in and a sense of gratification for a garden’s bounty (58). Thus as envisioned by the F2P/ECE movement, “the success of school gardens is a consequence of the benefits;” where children can eat what they grow and can have pride in their production (58). Likely garden production has additional benefits of fresher tasting produce, as well as a child’s familiarity with the products grown that could influence their interest in, and acceptance of, novel F/Vs. Evidence indicates that preschool children that almost always eat homegrown F/V in the home were 2.3 times as likely to eat the USDA recommended five daily servings of F/V, independent of parentage, race, income and educational attainment (59). While the F2P/ECE garden movement is in its early stages, several studies found that participating in agricultural school gardens increases pre-school aged children’s attitudes toward, preference for, and willingness to taste novel F/Vs (53,57,58,60-63). Additionally, agricultural gardening education has the added value of introducing a child to later life skills to pass on to their future generations (59).
The purpose of this policy review is to measure the prevalence of enacted and pending state-level legislation that promotes or creates F2P/ECE in the fifty United States and Washington, DC., and to analyze whether state policy legislation adequately supports the F2P/ECE movement. While there is forward momentum at the federal level to support the F2P/ECE movement, I propose that states’ F2P/ECE legislation is lagging and thus there exists ample room for improved state-level support and legislative implementation.
Farm-to-Preschool Policy Review:
For this policy analysis on F2P/ECE legislation, primary legal research was used to compile legislation from the subscription-based Westlaw legal research database through searches of state statutory and administrative law databases effective as of September 2000. The search was performed reviewing all fifty states and the District of Columbia (D.C.), in the summer and fall of 2017; and then updated in January – March of 2018. The Westlaw database was searched through a combination of natural language and Boolean keyword searches, as well as thorough reviews of states' statutory and administrative law code for the years of interest. The search was limited to state legislation and focused on looking for any language that included a tendency towards F2P or F2ECE policy or language, most often found within statues, state annual appropriations, policy statements, as well as congressional intent.  A total of 135 different search term databases were reviewed, with a total result of 9,471 electronic documents found and reviewed for relevance.
What resulted was a database of legislation that was classified by state, bill number, year and title; or state administrative regulation citations. The legislation was then further sub-classified to complement the three core elements of F2P/ECE. A fourth sub-classifications was included to capture what states were doing to examine the F2P/ECE movement. These classifications where thus titled; 1) F2P/F2ECE program; 2) F2P/F2ECE taskforce; 3) school gardens; and 4) local preference. The sub-classification “F2P/F2ECE program” addressed whether or not the state has legislative language that supported, recommended, required, and/or funded a state department to establish a local agriculture and food-related (fruit and vegetable) nutrition education program specifically for pre-school-aged children. Legislation that only included language for “Farm-to-School” or school district programs is not included in the results for purposes of this analysis, as this paper is limited to the discussion of legislative intent specifically for younger early care- aged children.
The “F2P/F2ECE taskforce” sub-classification addressed whether or not the state has legislative language that recommended or required the state to establish or create some sort of committee or task force to study and make recommendations to the state regarding local food sourcing, school gardens and/or food and agriculture education to pre-school-aged children in the state. The “school gardens” sub-classification addressed whether or not the state has legislative language that endorsed, recommended, authorized and/or funded gardens for F2P/ECE program activities. And finally, the “local preference” sub-classification addressed whether or not the state has legislative language that provided purchasing preference authority for state and/or locally produced agricultural products; offered some sort of financial incentive for purchasing state and/or locally produced agricultural products; or modified local procurement or contract requirements to allow for childcare facilities’ easier access to state and/or locally produced agricultural products.
Some of the state legislation found during the search process could be legally interpreted to implicitly expand on a state’s authority to impact younger non-school aged children in their programs or regulatory activities. These bills and/or legal authorities, however, fall outside the purview of the intended policy review, as it would require a separate analysis of each state’s F2P/ECE program potential based on each state’s existing legislation. Thus, these bills and legal authorities were not included in the results for purposes of this policy analysis.
The search identified a total of 30 legislative bills (21 enacted, nine pending); two-state regulations; one executive proclamation; and one state attorney general opinion; within the 50 states and D.C. that aimed to address the core elements of the F2P/ECE movement. (See, Table 1). A description of the findings is discussed by sub-classification.
Farm-to-Preschool/Early Childhood Education programs:
The search identified four bills in Colorado, Washington, D.C., New Hampshire and Vermont and one executive proclamation in Arkansas supporting or creating a F2P/ECE program or activities. The first of such legislation was enacted in Colorado in 2010 when the legislature presented and passed a bill that created the Farm-to-School Healthy Kids Act. The bill promoted increasing the use of local farm products in both schools and state-regulated childcare programs to encourage the consumption of healthy foods (66). While the legislation states that it “encourages regulated child care programs to increase their use of local farm and ranch products in their foodservice programs,” it stops short of explicitly implementing a funded F2P/ECE program (66). Rather, the bill supports the creation of an F2S program through the creation of an F2S task force that is generally tasked with increasing access to, and sources of, locally grown food products to schools (66). In 2013, New Hampshire’s legislature established the Granite State Farm to Plate Program, encouraging “state agencies to cooperate with public and private entities to support local, state and regional food systems.” (67). In the bill, the only language recognizing and promoting the needs of younger pre-school aged children was found in the legislative purpose and not in the main body of the bill, noting that the Granite State Farm to Plate Program was due to the growing demands from schools and childcare facilities necessitating such a policy (67). The New Hampshire bill stopped short of recommending a specific F2P/ECE program within the state. In October of 2014, Washington, D.C. proved to be a leader in the early childcare and F2 program arena as the first to implement a F2P/ECE law, the Healthy Tots Act of 2014, which encompasses one of the most expansive F2P/ECE legislations in the U.S. (68). The Healthy Tots Act establishes required appropriations for the F2P/ECE program within the District to provide support and resources to childcare facilities for F2P/ECE activities, including funding for the use of locally grown and unprocessed healthy foods and competitive grants for F2P/ECE programs and school gardens (68). Most recently, Vermont joined D.C. as a national leader in F2P/ECE undertaking by amending the extensive Rozo McLaughlin Farm to School Program authority in June 2017 to include early childhood education centers. The amendment allows for early childhood care centers to receive F2S funding for local food, garden supplies, field trips to farms, and other educational resources under the F2S program goals (69). Vermont’s bill also requires farm assistance to develop and implement educational opportunities for farmers to break into the early childcare food market, and offers professional development opportunities for childcare personnel “about strategies for procuring, processing, and serving locally grown foods, especially with regard to federal procurement program requirements,” as well as information about nutrition and obesity prevention (69). In September 2017 the Governor of Arkansas issued a proclamation establishing a Farm to School Month. In the statement, F2ECE programs are recognized as providing educational opportunities related to health, agriculture, nutrition, and school gardens, and are identified as a significant market for local and regional food products (70).
Farm to Preschool/Early Childhood Education Taskforce:
The search identified four state legislative bills in Texas, Massachusetts, Colorado, and Montana, that created a working group or task force addressing early childhood education nutrition and the use of locally grown agricultural products. The earliest of such task forces was established in 2009 when Texas’ legislature created the Early Childhood Health and Nutrition Interagency Council (71). The Council, under the authority of the state’s Department of Agriculture in coordination with representatives from other state departments that involved early childhood care, was tasked with reviewing the status and existence of nutrition programs in the state, including barriers to improving nutrition in early childhood care settings (71). The Texas task force authority is due to expire on September 1, 2019, unless the current Congress acts to extend the authority (71). Soon after Massachusetts’ legislature passed a bill establishing the Massachusetts Food Policy Council (72). The purpose of the council was to develop recommendations to advance the food system goals of the Commonwealth, including increasing purchasing of local agricultural products for school and summer meals and other child and adult care programs. In 2010, Colorado’s creation of the “Farm-to-School Healthy Kids Act” encouraged regulated childcare programs to increase their use of local farm products in their food service programs, and established an interagency task force to develop F2S program policies with these goals in mind (66). In 2011 Montana’s legislature passed a joint resolution requesting an interim committee study childhood hunger and ways to improve access to nutritious foods (73). The study would examine and make recommendations on improving children’s access to nutritious foods, including but not limited to programs based in child-care facilities and schools. It included ways in which organizations can share their expertise in growing one's own food and basic food preparation skills and to examine increasing local farm products in schools and childcare facilities.
Farm-to-Preschool/Early Childhood Garden Programs:
The search identified three state legislative bills in D.C., Arizona, and Vermont and one State Administrative Code in Mississippi that endorsed, recommended, authorized and/or funded gardens for F2P/ECE program activities. Washington, D.C.’s Healthy Tots Act of 2014 creates the authority and funding for competitive grants available to child development facilities participating in the Child and Adult Care Food Program (CACFP) for school gardens (68). Arizona state legislature passed an Act in 2016 allowing for regulatory exemption of school garden produce. The legislature created an exemption to the requirements of rules prescribing minimum standards for all food provided for human consumption by public institutions for “whole fruit or vegetable grown in a public school garden that is washed and cut on-site for immediate consumption” (74). Vermont’s 2017 amendment to the Rozo McLaughlin Farm-to-School Program now allows registered or licensed childcare providers to participate in its local foods grant program, which funds F2 items, including gardening supplies (69). The Mississippi administrative regulations for childcare facilities licensure incorporated within their Nutritional Standards requirements language that specifically states facilities are encouraged to have gardening projects with children to incorporate physical activity with nutritional education (75). The language offers that produce grown from the gardens can be served as nutritional snacks or used for purposes of nutrition education.
Local Farm Product Preference:
The search identified 25 state legislative bills (nine pending, 16 enacted) in 20 different states and D.C. (Alaska, Arkansas, California, Colorado, D.C.; Hawaii, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, New Hampshire, New York, Tennessee, Texas, Vermont, Wisconsin, and Wyoming), one State Attorney General procurement opinion in Arizona, and one State Administrative Code in Delaware for the local preference sub-classification. These bills and the administrative code recommended purchasing preference for state and/or locally produced agricultural products by offering financial incentives for local procurement of agricultural goods. This included modified local procurement requirements or contract requirements for state-run or regulated entities. These laws relax the burdens placed upon facilities that fall under procurement restrictions, thus allow for childcare facilities that receive funding under federally funded, state-run child nutrition programs easier access to locally produced agricultural products. Only D.C.’s Healthy Tot’s Act included local produce procurement incentives that were specifically intended for F2P/ECE program usage. Arkansas, Maine, New York, Tennessee, and Vermont each had local food procurement language that included programs to incentivize local food purchases by childcare centers; Alaska, Delaware, Hawaii, Louisiana, Maryland, Minnesota, Texas, Wisconsin, and Wyoming had local food procurement incentives for “schools”; and Colorado, Kentucky, Massachusetts and Montana had procurement incentives for any state agency or authority (See, Table 1). The Arizona State Attorney General procurement opinion addressed the state’s authority to utilize federal geographic preference options in state procurement of locally grown or raised agricultural products if the institution or school receives any funding through federal Child Nutrition Programs. While most of the legislation found under the search criteria were geared towards benefitting and endorsing local agricultural economic development rather than for benefitting school or childcare programs, the effect remains the same by creating avenues for more affordable and fresher, better-tasting local produce for children in childcare settings.
Federal Farm-to-Preschool/Early Childhood Education Legislation:
At the macro level, changes in our national government’s childhood obesity and health policy has provided for immense impacts in influencing health disparities by modifying our children’s environmental setting in the public schools. The Healthy Hunger-Free Kids Act of 2010 (HHFKA) that amended the Richard B. Russell National School Lunch Act established a Farm-to-School Grant Program with the goal to improve access to local foods in schools, as well as mandated a decrease in fat and sugar content and increase in whole grains, fruits and vegetables served under the National School Lunch Program (NSLP) (76,77). While political controversy still exists regarding the impact of this Act’s mandate on school lunches and children’s willingness to consume “healthier” foods, impacts of the HHFKA legislation have resulted in positive effects in childhood nutritional consumption at the grade-school level after implementation (78).
Under the USDA 2008 Farm Bill, local food procurement for school meals and snacks was encouraged by establishing the “geographic preference” option which allows state laws to provide a competitive advantage to locally-produced foods (45,79). These geographic preference options apply to all state agencies making purchases on behalf of any of the federal Child Nutrition Programs, including the NSLP, School Breakfast Program, Fresh Fruit and Vegetable Program, Special Milk Program for Children, and the CACFP (80). The purpose behind the preference for local foods was to boost economic opportunities for the U.S. agricultural industry, as well as increase the use of local, minimally processed nutritional foods served to children (52). Under federal competitive bidding laws, preferences cannot be exclusive or allow for quotas (80). The amended policy does allow states to provide preferential bidding laws towards local producers by explicitly requiring districts to provide a purchase preference for locally grown food, creating bidding advantage scores, or offering higher reimbursement for local products as incentives for school purchases (45,79,81).
The CACFP, part of the USDA’s Food and Nutrition Service, is a federal nutrition assistance entitlement program that serves more than 3.3 million low-income day-care aged children each day (82). Most legally operating childcare facilities, including family or group daycare providers, are eligible to participate, as well as Head Start programs not participating in the NSLP and School Breakfast Program (82,83). CACFP participants receive reimbursement for serving eligible meals to enrolled children that meet federal nutritional guidelines (82). Reimbursement levels are determined by economic need, based on either the location of the care center, the household income of the care provider, or the household income of the enrolled child (82). The CACFP is utilized by states and local governments to encourage childcare facilities to participate in underfunded F2P/ECE programs by providing the cost reimbursement for serving local, healthy foods to enrolled children (84). Addressing the nutritional needs of low-income children, such as F2P/ECE activities in the Head Start program are proving beneficial, as Head Start enrolled children in F2P/ECE programs were found to develop a significantly higher willingness among low-income preschool-aged children to have more favorable tastes associated with F/V consumption (37,85).
Understanding State-Level Legislation Impacts:
States play a crucial role in the success of childhood nutrition programs, thus state-level policymaking is imperative for establishing meaningful impact for the F2P/ECE mission. At the state government level, legislative policies for F2P/ECE run the full spectrum; from no F2P/ECE language in place; to piecemeal legislation or agency-induced policies; to fully funded F2P/ECE programs integrated into the state’s codified laws as well as within their government’s regulatory administrative systems. As evidenced by the research findings in Table 1 (above), the few states’ laws enacted for F2P/ECE include recommendations for implementation, direct funding, programmatic support, infrastructure, and task forces. Enacting state-level policies have the specific advantage of addressing unique barriers to integrating F2P/ECE program development within each state compared to the broader federal laws (45). State-level policies designed to improve the diet of young children by increasing the availability of, access to, and understanding of, F/V consumption within their physical environment, ultimately presents the opportunity to prevent childhood obesity and related chronic disease at a more tailored level due to the complexity and differing legislative policies within a state (86,87).
Since the inception of the F2S program and state-level laws, only a few researchers have endeavored to measure the impact of state legislation with the success of the F2S programs, and no studies were found on the impact of state legislation and success of F2P or F2ECE programs. The first such study on the legislative impact on F2S examined the extent to which state-level laws helped facilitate these programs (45,88). Schneider et al. analyzed the effect of state F2S – related laws on public elementary schools by conducting a pooled, cross-sectional analysis using state law variables compared to schools’ F2S participation rates. The researchers looked at two-state law variables; 1) whether states had laws that required the state’s department of agriculture and/or education to establish an F2S program, website, or mentioned a program; or not, and 2) whether the state law encouraged or required school districts/schools to give procurement preference to in-state grown agriculture; or not (88). Schneider et al. observed that states with F2S laws had significantly higher participation in F2S programs, measured as the percentage of schools in the state with a program (88). This increase in participation remained even after adjusting for state and school-level factors (88).
In 2013, Thompson et al. published a review of current F2S legislation related to F2S programs and categorized those bills by region, funding implications and the presence of other support structures for facilitating F2S participation (86). The findings highlighted that many state laws lacked monetary incentives or appropriate funding for participation, but the research did not examine F2S participation rates in relation to the different types of laws (86). That same year a study published by Taber et al. examined whether state laws that required F/V to be served in school meals showed an increase in F/V consumption among school-aged children (18). The study focused on children with limited F/V access in their homes. Taber et al. found a positive association between the laws requiring F/V served in school meals and greater F/V consumption, especially among those children with limited access to F/Vs in the home (18). A 2014 publication by Nicholson et al. analyzed the relationship between F2S laws and F/V availability in school meals (89). Their findings are meaningful for understanding state legislative impact on the F2 programs, as the results indicated that the existence of state-level F2S laws were significantly associated with an increased F/V availability in schools, even when these individual schools did not have F2S programs in their curricula (89).
Most recently, McCarthy et al. published a study in 2017 examining the association between the presence of F2S laws and the presence of F2S programs to determine if school districts in states with these laws had higher participation (45). McCarthy et al. found that districts in states with F2S laws were more likely to have programs and were more likely to serve local food at high, medium or low frequencies than not at all compared to districts in states without F2S laws, supporting Nicholson’s research findings above (45). While more research is needed to understand the magnitude of state legislative impacts on the F2S and F2P/ECE settings in a state, the above findings are promising for legislative impacts.
Recommendations for State Legislation:
The public health arena’s historical approach to improving diet, and ultimately prevent and reduce childhood obesity by focusing on individual health and lifestyle behaviors has not proven effective or lasting (26). While obesity is driven by diet and physical activity during an individual’s lifetime, understanding the root cause of obesity is complex, as studies have found that this disease is a multifaceted problem with numerous intertwining health determinants (90). Over the last three decades, hundreds of studies have examined this issue, many finding that the problems are not only related to diet and exercise, but rather a multitude of factors at various levels, including a child’s physical environment, socio-economic status, and race/ethnicity (47,87,91-93).
With this in mind, our political representatives need to give greater consideration to encouraging the forward momentum for change in state policies that shape a child’s environment; i.e. “the physical and social contexts whereby health and lifestyle behaviors are patterned and thus adopted” (26). This is especially important in the early childcare and preschool setting where children are captive audiences to the facility’s teachings and instructional activity levels and where there is a greater likelihood of successful impact (47). Creating legislative policy change at this younger pre-school age is critical to increasing the magnitude and reach for established healthy dietary behaviors early in life that carry into adolescence and ultimately into adulthood, resulting in greater preventative measures for obesity, type 2 diabetes, heart disease and other chronic diseases (17,18). By shifting well-established legislative policy for F2S programs towards addressing this youngest group in childcare facilities, our country could be forming a new generation of more health-minded individuals geared for positive change.
There is limited research available to assert that state-legislation is imperative for the success of the F2P/ECE movement. Without legislation, F2P/ECE programs may still become established by grass-roots efforts, by non-governmental organizations interested in the mission, or through state agency piece-meal authority. But to establish comprehensive F2P/ECE programs that are more permanent and result in longer-term impacts for its constituents, legislative policy implementation is required that can be funded and enforced (94). It is evident from the outcomes of state F2S legislation that such legislation provides for promising impacts for our children. State legislation is especially important to create wide-ranging impacts, whereas state F2S laws indicate increased F/V availability and consumption, regardless of whether the individual schools within the state establish an F2S program (18,89). Because the F2P/ECE movement is still in its infancy, this presents an ideal opportunity for state representatives to be innovative by molding the F2P/ECE policy needs specific for their state constituents.
The current state of F2P/ECE legislation in the U.S. is meek, at best. Only Vermont and Washington, D.C. present as model leaders for states in this arena, providing a comprehensive legislative language for funded F2P/ECE program authority. The other 49 States’ Representatives need to acknowledge the importance of early preventative interventions to address our obesity epidemic and related diseases and should consider similar F2P/ECE legislation for their state. Most importantly, legislative action needs to be taken that sets clear stated policy goals for addressing health disparities in low-income preschool-aged children to allow for on-going and consistent access to, and education regarding fresh, micro-nutrient rich F/V other than French fries or potato chips as primary vegetable sources (87). By implementing legislative policy change that supports the F2P/ECE movement, it provides for greater opportunities to address health disparities for this vulnerable group and allows for more exposure to fresh, varied F/V where it is lacking in the home setting.
Reaching our younger pre-school-aged children through legislation may meet with some challenges. Early childcare facilities are established under a variety of different arrangements; from government-run, non-profit, for-profit and home-based care facilities. Unlike F2S laws that can address all school-aged children that attend a unified public school system, states need to be more creative when examining F2P/ECE implementation. The F2P/ECE legislation from Vermont and Washington, D.C. that currently are in place can provide for model language to introduce for passage. Legislative sponsors may, however, find difficulty in moving similar bills through enactment due to the inarguably complex balance of other state interests and limited annual funding. While there is more legislative movement along the lines of local agricultural procurement laws, the passage of this level of legislation without corresponding F2P/ECE laws is likely due to the immediate economic implication for local producers rather than for early childhood nutrition purposes. Understanding how the legislature is motivated to move bills forward for implementation, however, can provide for more sophisticated action for public health proponents when promoting F2P/ECE laws, such as partnering F2P/ECE with other state interests such as agriculture, environment, and education.
Other suggestions for state legislative action within the F2P/ECE movement may include; enhancing state CACFP standards to incorporate F2P/ECE activities (83); requiring state regulations for all early childhood facilities to meet CACFP standards to provide the gateway to include more F2P programs (83); requiring F2P/ECE training and education within childcare facility licensure requirements (84), and requiring childcare facilities to meet specific F2P/ECE nutrition standard requirements for licensure (84).
After extensive research of all 50 states’ and Washington, D.C.’s legislation, it is apparent that the amount and quality of F2P/ECE legislation inadequately addresses F2P/ECE needs, thus has immense room for improvement. Whereas studies clearly indicate that childhood dietary patterns are established early in life and that a young child’s taste preference and weight tracks through adulthood, addressing obesity prevention at the primary years can have life-lasting implications. Considering what we know about the impacts of daily nutrition, it is telling that F/V consumption is a global key factor in reducing the incidence of obesity and preventing future chronic illness and disease. Implementing state legislation to expose and condition the dietary patterns of our youngest population to healthy, fresh F/V’s could be an essential tool for creating a substantial impact. As early childhood care centers tend for the majority of our youngest population, there is a distinct opportunity for legislators to create legal avenues for F/V exposure to this captive audience with F2P/ECE program implementation. Legislative representatives should take advantage of the current trend towards partnership between childhood nutrition and obesity action, local agricultural promotion, environmental policy, and hunger advocate efforts with the F2P/ECE movement by presenting legislation that will positively impact these multiple sectors in their states.
Even with the limited research on the effects of enacted state legislation on F2S programs, results show positive associations. More research is needed to understand the association between specific types of laws and F2S programs and especially F2P/ECE participation to best understand and improve the effectiveness of these laws so future legislation can be presented to best address the needs of our youngest children. Additionally, the lack of F2P/ECE laws only emphasizes the expansive possibilities for legislatures to show their support for expanding childhood nutrition efforts and local producer economic stability.
Note: This article was prepared while Margaret A. Burns-Rath was a student of Johns Hopkins University, Bloomberg School of Public Health. The opinions expressed in this article are the author's own and do not reflect the view of the Food and Drug Administration, the Department of Health and Human Services, or the United States government.
 A 2016 longitudinal study by Maier-Nöth, et al. found that children who were repeatedly exposed to a variety of vegetables from weaning and early childhood, consumed more, liked more, and had higher acceptance of to vegetables when examined from 15 months, 3 years and then 6 years of age (30).
 By creating an educational component to F/V consumption, Osborne and Forestall’s research found that between the ages of 4 to 8 years old, children that were repeatedly exposed to nutrition information through picture books as well as to new varieties of fruit were more likely to accept and try new fruits (31).
 Search terms used were limited to: farm; garden; “community-supported agriculture”; preschool; daycare; childcare; pre-kindergarten; “early childhood education”; school; produce; vegetable; nutrition; crop; agriculture; local; procurement; “small purchase threshold”; nutrition; food; "farm-to-school"; "farm-to-preschool"; and "farm-to-ECE". These terms were utilized in various combinations in the advanced search feature of Westlaw to narrow the search results, i.e. ((preschool or "early childhood education" or "childcare") and (food /p farm /s program)); or ((preschool or "early childhood education" or "childcare") and (local /p vegetable)).
 Legislative documents that were relevant for F2S, F2P or F2ECE programs, funding or local procurement were reviewed for repetitiveness and whether the legislation was either pending or codified. Legislation that was effective but expired due to sunset laws or in force for a limited time was noted.
 Additional research was performed using the Google search function for state government websites using each individual State name (i.e. “Alabama” or “Alaska”) and “Farm to Preschool” or “Farm to School” or “Farm to Early Childhood” to determine what governmental departments within each state had activity or authority over F2P/ECE programs, as this did not appear to be consistent. For example, Alabama governs the F2P programs through their Department of Education, Child Nutrition Programs (65) while Maine has its F2P program resources and information under its Department of Health and Human Services that controls early childhood care licensing.
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