Cosco and colleagues evaluated the effectiveness of a Preventing Obesity by Design (POD) intervention implemented in 27 licensed childcare centers in North Carolina using an assessment of the quality of the outdoor environment, observation of children's behavior, and interviews with center directors. The POD intervention model includes funding to support changes to the childcare center outdoor environment. In addition to intervention design assistance, site assessments, staff training, and technical assistance, evaluation services were provided to participating childcare centers. Evaluation results indicate a statistically significant increase in physical activity level following completion of the built environment renovation. 68% of center directors interviewed after the renovation reported a positive change in children's behavior. Observations of children suggested that 22% of children were more likely to be engaged in an active pursuit after renovation than prior to intervention implementation. 40% of center directors mentioned the installation of edible plant gardens as the greatest success, providing opportunity for children to taste new types of fruits and vegetables. Another area of focus for investigators was measuring the impact of altering the path layout (for riding toys) from straight and linear to a looped pattern which crossed the interior of the playspace. This feature change was associated with higher physical activity level than the straight/linear type. Lastly the study measured the effect of teacher and child interaction on activity level. A negative relationship was observed, suggesting that when teachers interact with children, physical activity level decreases.
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