Methods
The “Painted Playgrounds” was a randomized controlled trial study occurring in four ECE centers (two intervention; two waitlist control). The centers were identified using a public list assembled by the state Department of Education comprised of licensed ECE centers within a metropolitan county of a southeastern U.S. state. ECE centers were eligible if they were currently licensed, enrolled at least 20 children between the ages of three to six years, and had available concrete area within their outdoor play environment to allow for stenciling three designs. Trained researchers reviewed the outdoor play setting and assessed eligibility of available area for stenciling (i.e., square footage and surface substrate). If ECE centers were eligible, written approval and consent were obtained from the ECE center’s director/administrator to allow for the playground stenciling and playground observations.Preschoolers at these ECE centers were eligible if they were between the ages of three to six years, enrolled full-time (at least six hours/day, five days/week), and planned to attend the same ECE center for the study duration (the following eight to nine weeks). Parents/guardians of preschoolers provided written consent for the child measurements (i.e., height, weight, accelerometry) and were provided with an opt-out letter as passive consent for the playground observation. The study was also explained in a child-friendly manner to participants, and preschoolers were given the opportunity to refuse measurements. The study protocol was approved by the Institutional Review Board (IRB) of Pennington Biomedical Research Center.