1

Shape NC Evaluation Report: Final Report

Shape NC 

Evaluation Report: 

Final Report
Shape NC 

Evaluation Report: 

Final Report

Authors:

Jill Feldman 

Shauna Harps 

Atsushi Miyaoka 

Matt Finster 

Kim Standing 

Jennifer Schaaf 

Westat

August 2020
Shape NC Evaluation Report: Final Report

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Contents

Acknowledgments. ..............................................................................V

Executive Summary ................................................................................. VI

Background and Introduction. .......................................................................................................................... VI

Evaluation Methods and Measures. .................................................................................................................. X

Baseline Equivalence of Treatment and Comparison Groups. ........................................................................VII

Impacts After 1 and 2 Years of Shape NC Shape NC Technical Assistance. .................................................VII

Conclusions and Study Limitations. ...................................................................................................................X

Background and Introduction. ................................................................. 1

National Prevalence of Childhood Obesity and Related Effects........................................................................ 1

Childhood Obesity in North Carolina.................................................................................................................. 2

Role of Early Education in Preventing Childhood Obesity ................................................................................. 2

Overview of Shape NC TA..............................................................................................................................................3

Evaluation Methods and Measures. ........................................................... 5

Research Questions ........................................................................................................................................... 5

Measure. ............................................................................................................................................................. 6

Response Rate. .................................................................................................................................................. 6

Baseline Equivalence of Treatment and Comparison Groups. ........................... 8

Site Level Equivalence ....................................................................................................................................... 8

Child-level Equivalence. ...................................................................................................................................11

Impacts After One and Two Years of Shape NC Implementation. ......................14

Analysis Approach ............................................................................................................................................ 14

Impacts after 1 and 2 Years. ........................................................................................................................................ 15

Conclusions and Study Limitations. .........................................................24

References. ......................................................................................25

Appendix A. Imputation. .......................................................................28

Program Theory and Logic Model. ................................................................................................................... 28

Appendix B. Methodology ..........................................................................31

Impact Study .................................................................................................................................................... 31

Appendix C. Imputation. .......................................................................37

Appendix D. Supplemental Baseline Equivalence Data. ................................. 39

Appendix E. HML Tables. ..........................................................................44

Appendix F. Outcome Data Disaggregated by County ..................................... 46
Shape NC Evaluation Report: Final Report

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List of Tables

Table 1. Instruments and response rates. .......................................................................................................... 7

Table 2. Percentages of sites with previous health-related program experience. ........................................... 13

Table 3. Impact questions, outcome measures, and analytic approach. ......................................................... 13

Table 4. Number of children in each weight category ...................................................................................... 22

Table 5. Children’s movement between BMI categories from baseline to follow-up. ...................................... 23

Table A-1. Data sources used to address impact questions. .......................................................................... 30

Table B-1. Group Assignments, by year .......................................................................................................... 33

Table B-2. Number of sites, children included in the analysis, and MDE, by number of years of treatment. . 36

List of Figures

Figure E-1. Changes in types of indoor physical activities between baseline and follow-up. ...................... VIII

Figure E-2. Changes in types of outdoor physical activities between baseline and follow-up.................... VIIII

Figure E-3. Percentage of children in BMI weight categories between baseline and follow-up. ......................X

Figure 1. Number of sites with food and beverage policies. ............................................................................. 9

Figure 2. Number of sites with physical activity policies. ................................................................................. 10

Figure 3. Percentages of children in each group with key characteristics. ..................................................... 12

Figure 4. Changes to food and beverage policies from baseline to follow-up. ............................................... 16

Figure 5. Changes in types of indoor physical activities between baseline and follow-up. ............................ 17

Figure 6. Changes in types of outdoor physical activities between baseline and follow-up. .......................... 19

Figure 7. Percentage of children in BMI weight categories between baseline and follow-up. ....................... 21

List of Exhibits

Exhibit A-1. Shape NC logic model. ................................................................................................................ 29

Exhibit B-1. Impact Study: Quasi-experimental delayed treatment design. ................................................... 33

Exhibit B-2. Number of children in each cohort receiving the treatment, by age. .......................................... 36
Shape NC Evaluation Report: Final Report

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Acknowledgments

We gratefully acknowledge the contributions of a number of individuals in the preparation and production 

of this report.

We would like to thank Shape NC technical assistance and research staff at the North Carolina Partnership for 

Children, especially the Shape NC coaches and subgrantees for their collaboration and assistance with childcare 

site recruitment, data collection, and support developing the implementation framework. In addition, we would 

like to thank the directors, parents, and children at treatment and comparison sites who contributed data to the 

study and for their willingness to share their experiences with us, and to staff who helped with logistics on the 

days data collectors were at their sites collecting data from children.

The study would not have been possible without contributions from other individuals at Westat—in particular, 

we thank Rob Olsen for his thoughtful feedback and suggestions on this report, Priscilla Quintanilla and Mihiri 

Silva for recruiting, training, and managing our highly skilled team of assessors and for making data collection 

run smoothly. We thank Valerie Orellana for her contributions creating analysis files and for producing tables 

and figures for the report. Other Westat staff who made important contributions to data collection or reporting 

include Marsha Lyons, Clarissa McKithen, Laura Collins, and Sylvie Warren.
Shape NC Evaluation Report: Final Report

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Executive Summary

Background and Introduction

Shape NC is a technical assistance (TA) model 

used in childcare settings to improve health and 

nutrition practices, increase physical activity, and 

engage children and childcare providers in healthy 

lifestyle activities. Through the model, Shape NC 

coaches partner with subgrantees (TA providers) 

to serve childcare sites in four counties in central 

North Carolina (Randolph, Durham, Wake, and 

Wilson). Shape NC coaches integrate three programs 

to increase the use of wellness best practices in 

childcare sites: 1) Be Active Kids® (to increase 

indoor and outdoor physical activity), 2) Nutrition 

and Physical Activity Self-Assessment for Child 

Care (tools to measure best practices), and 3) the 

Natural Learning Initiative (promotes the design of 

children’s natural outdoor learning environments to 

increase opportunities for physical activity). Coaches 

also provide implementation support for Farm 

to Early Care and Education and Carolina Global 

Breastfeeding Institute programs; however, these 

programs were not included in the evaluation.

This report describes results of Westat’s evaluation of 

Shape NC TA using data collected from participating 

childcare sites and children in fall 2017, spring 2018, fall 

2018, and spring 2019.

Problem Definition 

Obesity rates and poverty are serious issues in North 

Carolina. Statewide, 29.7 percent of children age 2–4 

are overweight or obese and rates of adult obesity 

almost tripled rising to 30.1 percent in 2015 from 12.3 

percent in 1990 (Trust for America’s Health and the 

Robert Wood Johnson Foundation, 2016). Poverty, too, 

is higher among the state’s young children at 16.4 

percent, compared to the national average of 13.5 

percent (Census Bureau, 2015). Also illustrating the 

magnitude of the problem in North Carolina is that 61 of 

the state’s 100 counties have obesity rates among low 

income 2–4 year olds that exceed the state average. 

Evaluation Methods and Measures

To examine the effect of Shape NC TA on treatment 

sites and children enrolled in the sites, the evaluation 

team collected a variety of data at the site level (e.g., 

site director surveys and interviews) and the child 

level (e.g., height and weight). Westat recruited two

cohorts of childcare sites for participation in the study. 

Baseline data were collected during the fall following 

recruitment (fall 2017 for cohort 1, fall 2018 for cohort 

2), and follow up data were collected during 

the subsequent spring for both cohorts (spring 2018 

for cohort 1, spring 2019 for cohorts 1 and 2) and 

again the following fall for cohort 1 (fall 2018).
Shape NC Evaluation Report: Final Report

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Spring data collection was conducted as close to the 

end of the school year as possible. The evaluation 

team used the same procedures and timeline to collect 

data from sites and children with parental consent in 

the treatment and comparison groups. 

Baseline Equivalence of Treatment 

and Comparison Groups

Since the impacts of the program are estimated by 

comparing the treatment and comparison groups 

after the program was implemented, it is important 

for the two groups to be comparable at baseline. 

Westat conducted statistical tests to identify mean 

differences between the treatment group and the 

comparison group and confirm that sites had similar 

wellness policies and practices, and body mass 

index (BMI) measurements.

Director survey results indicated that sites in each 

group were statistically similar regarding baseline 

wellness policies and practices. The evaluation team 

also compared baseline child-level outcomes and 

found no significant differences between children in 

the treatment and comparison groups.

Despite efforts to limit recruitment to sites with no prior 

exposure to Shape NC resources (i.e., Be Active 

Kids® [BAK®], Go Nutrition and Physician Activity 

Self-Assessment for Child Care [NAPSACC], Natural 

Learning Initiative [NLI]), data indicate sites in each 

group had prior program exposure. Approximately 

half of directors in both treatment and comparison 

sites indicated at baseline they were currently 

implementing or had previously implemented a Shape 

NC resource or similar program targeting similar 

outcomes. Prior exposure to Shape NC resources or 

initiatives targeting similar outcomes is a nontrivial 

potential source of bias for the comparison group. It 

is important to acknowledge that comparison sites 

had prior experience implementing wellness initiatives 

when interpreting results about the impact of Shape 

NC TA.

Impacts After 1 and 2 Years of Shape 

NC Shape NC Technical Assistance

The evaluation team examined the impact of Shape 

NC TA on (1) childcare site policies and practices, 

(2) indoor physical activities, (3) outdoor physical 

activities, and (4) children’s BMI.

There was no significant impact of Shape NC TA on 

the number of nutrition polices and best practices after 

1 or 2 years of implementation. Aligned with licensing 

requirements, most treatment and comparison sites 

had informal or written policies related to food 

brought from home and staff consumption in front of 

children.

Shape NC TA had a significant positive impact on 

the number and types of indoor physical activities 

available to children at treatment sites, especially 

after 2 years. There were significant increases in sites 

offering indoor free play, structured play/organized 

games, balancing, and stretching (Figure E-1).

There were statistically significant increases in the 

number of treatment sites that offered children 

opportunities for outdoor physical activities, 

using grant funds to partially offset the cost of 

implementing their natural learning environment 

design plan. These increases were significant 

after 1 and 2 years (Figure E-2). For example, 

after 2 years of treatment, the number of sites in 

which children participated in outdoor structured 

play/organized games increased to 17 from four 

at baseline (p < 0.01).

More than two-thirds of children in both treatment 

and comparison groups were in the healthy weight 

category at baseline and most stayed in the healthy 

weight category after 1 or 2 years of treatment. Data 

also suggested that comparison sites, on average, 

had a significantly higher proportion of children at a 

healthy weight (p=0.04) (Figure E-3).
Shape NC Evaluation Report: Final Report

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Figure E-1. Changes in types of indoor physical activities between baseline and follow-up

* The percentage of sites at follow-up is statistically different from the percentage of sites at baseline (p < .05).

NOTE: Findings for sites after two years of treatment include data from cohort 1 sites that received treatment in both years (Year 1 

and Year 2). Findings for sites after one year of treatment include data from treatment sites in Year 1 (cohort 1) and Year 2 (cohort 

2). Findings for comparison sites include data from the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019.
Shape NC Evaluation Report: Final Report

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Figure E-2. Changes in types of outdoor physical activities between baseline and follow-up

* The percentage of sites at follow-up is statistically different from the percentage of sites at baseline (p < .05).

NOTE: Findings for sites after two years of treatment include data from cohort 1 sites that received treatment in both years (Year 1 

and Year 2). Findings for sites after one year of treatment include data from treatment sites in Year 1 (cohort 1) and Year 2 (cohort 

2). Findings for comparison sites include data from the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019.
Shape NC Evaluation Report: Final Report

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Figure E-3. Percentage of children in BMI weight categories between baseline and follow-up

* The percentage of children at follow-up is statistically different from the percentage of children at baseline (p < .05).

NOTE: Findings for children that received two years of treatment include data from children in cohort 1 that received treatment 

in Year 1 and Year 2. Findings for children that received one year of treatment include data from children at the treatment sites in 

Year 1 (cohort 1) and Year 2 (cohort 2). Findings for children in the comparison group include data from children at the comparison 

sites in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019.

Conclusions and Study Limitations

The evaluation team planned to collect child height 

and weight data for 3 consecutive years from children 

enrolled at participating childcare sites. Due to 

COVID-19 guidelines and restrictions, spring 2020 

data collection was cancelled and Westat used data 

collected during the first 2 years of the program 

to evaluate the child-level program outcomes. 

In addition to disruptions caused by COVID-19, 

ceiling and testing effects led Westat to discontinue 

interviews with 2-year-old children about their food 

and activity preferences. 

This change left the less sensitive BMI outcome as 

the sole child-level outcome measure.

Shape NC TA had a statistically significant positive 

impact on the number and types of opportunities 

for indoor and outdoor physical activity offered to 

children at participating sites. There was no evidence 

to suggest Shape NC TA affects the percentage of 

participating children at a healthy weight. Over twothirds of children in both groups were at a healthy 

weight throughout the study.
Shape NC Evaluation Report: Final Report

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1 Background and Introduction

This section provides an overview of research related to childhood obesity 

nationally and in North Carolina, the effects of not being at a healthy weight, 

and the role of childcare sites in obesity prevention. It also includes a description 

of the goals of Shape NC technical assistance (TA).

National Prevalence of Childhood 

Obesity and Related Effects

Obesity rates of children and adolescents in the 

United States have generally risen over the past 25 

years (Ogden et al., 2016) and remain high despite 

attempts to counter them. National data from 2015–

16 indicate that the prevalence of obesity was 13.9 

percent among young children aged 2–5 years and 

18.4 percent among children aged 6–11 years (Hales, 

Carroll, Fryar & Ogden, 2017). Observed disparities 

in obesity rates among children of different races 

(Hales et al., 2017) and income levels (Lee, Andrew, 

Gebremariam, Lumeng, & Lee, 2014) are also a 

cause of concern. Obesity rates are higher among 

poor children and evidence suggests the magnitude of 

this disparity is increasing (Datar & Chung, 2015), with 

differences beginning as early as kindergarten (Singh, 

Siahpush, & Kogan, 2010). Studies have shown that 

obesity rates tend to decline as children age, leading 

researchers to underscore the importance of obesity 

prevention during early childhood, before children 

become obese (Cheung, Cunningham, Naryan, & 

Kramer, 2016). Promoting young children’s healthy 

nutrition and physical activity is particularly important 

given the prevalence and risks of overweight 

and obesity.

Children who are obese are at risk for negative 

outcomes during childhood that last into adulthood. 

Obese children and adolescents face significant 

health risks (Ebbeling, Pawlak, & Ludwig, 2002) 

and are about five times more likely to be obese as 

adults than their counterparts who are not obese 

(Simmonds, Llewellyn, Owen, & Woolacott, 2016). 

These findings underscore the need for obesity 

prevention efforts to reduce the likelihood of obesityrelated health risks that begin in childhood from

continuing into adulthood. For example, adults who 

are obese are at risk for serious diseases including 

cardiovascular disease, kidney disease, diabetes, 

and cancer (Lauby-Secretan et al., 2016; Singh et 

al., 2013). In addition to adverse health effects, 

overweight or obesity in childhood is associated with 

negative school outcomes such as: reduced math and 

reading skills; decreased executive functioning skills; 

increased detention, absenteeism, and tardiness; 

and negative social-behavioral outcomes, including 

increased internalizing and externalizing behavior 

problems and ADHD (Datar & Sturm, 2006; Davis & 

Cooper, 2011; Pulgaron, 2013; Shore et al., 2008). 

In addition, children who are obese or overweight 

experience negative outcomes as adults, including 

fewer years of education, lower marriage rates and 

household income, and higher poverty rates (Dietz, 

1998; Gortmaker, Must, Perrin, Sobol, & Dietz, 1993). 

Of critical importance is that children are exposed to 

healthy nutrition and physical activity from an 

early age.
Shape NC Evaluation Report: Final Report

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Childhood Obesity in North Carolina

Obesity rates and poverty are serious issues in North 

Carolina. Among all states, North Carolina is among 

the top half of states reporting the highest obesity 

rates among children 10–17 years old (Trust for 

America’s Health and the Robert Wood Johnson 

Foundation, 2016). Statewide, almost a third (30%) of 

children age 2–4 are overweight or obese (Trust for 

America’s Health and the Robert Wood Johnson 

Foundation, 2016). Additionally, North Carolina 

was one of only three states in which there were 

statistically significant increases in obesity over a 

6-year period, according to results from Pan et al.’s 

(2019) study of state-level obesity rates among 

WIC-enrolled children between 2 and 4 years of age. 

Research has also shown a negative relationship 

between socioeconomic status and obesity (Cheung 

et al., 2016). Poverty, too, is higher among North 

Carolina’s residents at 14.0 percent, compared to the 

national average of 11.8 percent (United States 

Census Bureau, 2019). Childcare providers are 

uniquely positioned to cultivate habits during early 

childhood that are likely to lead to a healthy weight 

among the infants and toddlers in their care.

as key development domains. A related framework 

developed by the Early Childhood Systems Workgroup 

includes “health, mental health, and nutrition” as one of 

the four core components of an early childhood system 

designed to promote school readiness (Bruner, 2011). 

The Whole School, Whole Community, Whole Child 

(Lewallen, Hunt, Potts-Datema, Zaza, & Giles, 2015) 

model emphasizes relationships between learning and 

health, and includes health education, nutrition 

environment and services, physical education and 

physical activity, and community supports among its 

core components (Chiang, Meagher, & Slade,

2015; Lewallen et al., 2015). Additionally, a review 

of obesity prevention interventions targeting young 

children indicated that most interventions reviewed 

were implemented in early education centers with 

children from economically disadvantaged families and 

varied racial and ethnic backgrounds (Volger, Radler, 

& Rothpletz-Puglia, 2018).

In North Carolina, about 40 percent of children aged 

0–4 years are served by over 4,600 childcare centers. 

More than a quarter of these children (26%) are living 

in poverty, as indicated by data about the proportion 

of children in care who are eligible to receive subsidies 

(North Carolina Department of Health and Human 

Services, 2017). Staff in childcare sites are able to 

influence the nutrition and physical activity of the 

children in their care, which is especially important 

to children living in poverty who are at higher risk 

for obesity. Research indicates that early exposure 

to healthy food and physical activity can lead to 

a lifetime of healthy choices (Moore et al., 1991; 

Skinner, Carruth, Bounds, & Ziegler, 2002), providing 

 further support for interventions implemented in

Role of Early Education in 

Preventing Childhood Obesity

Links between children’s physical health and academic 

achievement have been well-researched over the 

past decade. Numerous studies and meta-analyses 

demonstrate the importance of nutrition and fitness 

to academic achievement (Asigbee, Whitney, & 

Peterson, 2018; Centers for Disease Control and 

Prevention, 2010; Fedewa & Ahn, 2011; Rampersaud, 

Pereira, Girard, Adams, & Metzl, 2005). Combined 

with an understanding of the relation between 

children’s physical health and adult health outcomes, 

these findings have prompted calls for integrating 

wellness initiatives within educational settings.

In response, several recently developed frameworks 

integrate wellness policies and practices that promote 

child health within educational contexts. In 2005, the 

National Governors Association Task Force on School 

Readiness released Building the Foundations for Bright 

Futures, a framework emphasizing the importance 

of early motor development and physical well-being

In North Carolina,

30%

of children ages 2-4 

are overweight or obese

(Trust for America’s Health and the 

Robert Wood Johnson Foundation, 2016)
Shape NC Evaluation Report: Final Report

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childcare settings that target young children living in 

poverty. By focusing on children’s early experiences, 

childcare sites are uniquely positioned to promote 

healthy habits that can last a lifetime. Although 

previous evaluations of Shape NC TA suggest it can 

have positive effects on childcare sites’ nutrition and 

physical health policies and practices (De Marco & 

De Marco, 2016; Vaughn, 2013), the present study 

is the first rigorous evaluation of the program to be 

conducted.

Overview of Shape NC TA

Shape NC began in 2011 as a partnership between 

the North Carolina Partnership for Children (NCPC) 

and the Blue Cross Blue Shield of North Carolina 

Foundation (BCBSNCF) as a preventive approach to

support Shape NC implementation, a design plan for 

expanding the outdoor learning environment, and 

funds to offset costs of implementing the program 

(average spending is $10,423 for each treatment site in 

year 3). By targeting sites that serve high percentages 

of children living in poverty, the Shape NC TA aims to 

maximize positive outcomes among sites that serve 

children with the greatest need for support.

Shape NC integrates three programs to increase sites’ 

use of wellness policies and best practices:

• Be Active Kids® (BAK®): A signature health 

program of BCBSNCF designed to increase indoor 

and outdoor physical activity of children and adults 

in early care and education settings.

• Nutrition and Physical Activity Self-Assessment 

for Child Care (Go NAP SACC): Online tools 

developed by the University of North Carolina 

at Chapel Hill (UNC-Chapel Hill) researchers to 

measure best practices in early care and education 

programs, policies, and environments in five content 

areas: Breastfeeding and Infant Feeding, Child 

Nutrition, Infant and Child Physical Activity, Outdoor 

Play and Learning, and Screen Time.

• The Natural Learning Initiative (NLI): A project 

developed at North Carolina State University 

that promotes the design of natural outdoor learning 

environments to enhance children’s daily 

experiences and wellness.

promote children’s healthy weight. Shape NC is a TA

model used in childcare settings to improve health 

and nutrition practices, increase physical activity, and 

engage children and childcare providers in healthy 

lifestyle activities. Taken together, Shape NC programs 

provide young children with early exposure to healthy 

foods and physical activity to cultivate habits and 

preferences leading to a lifetime of healthy choices. 

Through the program, site directors (and the teachers 

they select) receive training and monthly TA to

The North Carolina Partnership 

for Children and the Blue Cross 

Blue Shield of North Carolina 

Foundation partnered to offer 

Shape NC, an obesity prevention 

approach that promotes 

children’s healthy weight,

to childcare providers.
Shape NC Evaluation Report: Final Report

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Previous research shows that Shape NC TA can have

positive effects on childcare sites’ nutrition and 

physical health policies and practices (De Marco & 

De Marco, 2016; Vaughn, 2013). Westat’s evaluation 

extends on the two prior evaluations of Shape NC TA 

by estimating cross-cohort and multiyear impacts of 

Shape NC on site practices and children’s weight 

using a quasi-experimental design (QED). Application 

of a QED across participating counties 

yielded results that meet the Social 

Innovation Fund’s definition of 

moderate evidence. For the

current study, Shape NC TA

staff worked with four subgrantees that each recruited 

sites to implement the program and participate in the 

evaluation. Participating sites served children within 

four counties in central North Carolina: Durham, 

Randolph, Wake, and Wilson.1

The remaining sections of this report provide an 

overview of the evaluation and methodology, as well 

as descriptions of the evaluation measures, data 

collection activities, baseline equivalence of treatment 

and comparison sites and children, and impacts of 

the program.

2

3

1 4

5

1.

2.

3.

4.

5.

Randolph

1 Sites were recruited from neighboring Johnston County during the 2018-2019 school year. Data from this county were combined 

with data from Wilson County as there were too few childcare sites in Wilson County that met the eligibility criteria for an 

adequately powered study.

 
Shape NC Evaluation Report: Final Report

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2 Evaluation Methods and Measures

This section summarizes Westat’s methods for evaluating Shape NC TA and the 

measures used for the study. It also includes information on cohorts of 

participating childcare sites and the timeline for data collection.

To examine the effect of Shape NC Technical 

Assistance (TA) on outcomes after 2 years and 

answer the research questions, Westat collected a 

variety of data at the site level and child level. Westat 

collected baseline data in fall 2017 (Cohort 1 treatment 

group and Cohort 2 comparison group) and fall 2018 

(Cohort 2 treatment group and Cohort 3 comparison 

group), and followup data in spring 2018 (Cohort 1 

treatment group and Cohort 2 comparison group) 

and spring 2019 (treatment group composed of 

Cohorts 1 and 2 and Cohort 3 comparison group). 

The evaluation team followed the same procedures 

and used the same data collection timeline for 

the treatment and comparison groups. Additional 

information on the program theory and evaluation 

methodology are in Appendices A and B, respectively.

Research Questions

The evaluation estimates program effects after 1 and 

2 years and focuses on site- and child-level outcomes. 

The impact evaluation contributes evidence of Shape 

NC’s influence on childcare site practices and child 

outcomes and was designed to answer these 

research questions:

1. What is the impact of Shape NC TA on the number

of health and nutrition best practices implemented 

in participating childcare sites receiving 1 or 2 years 

of treatment relative to comparison sites?

What is the impact of Shape NC TA on attitudes 

of participating children toward healthy eating 

and physical activity relative to children in 

comparison sites?

What is the impact of Shape NC TA on the 

percentage of participating children at a healthy 

weight as measured by child body mass index (BMI) 

status relative to children in comparison sites?

2.

3.

Study Modifications

There were two modifications to the SIF 

Evaluation Plan (SEP) since approval of the 

original plan. 

NCPC, in consultation with Westat, eliminated 

cohort 4, which was meant to serve as the 

comparison group for cohort 3. Cohort 4 was 

never intended to receive services under the grant 

so there is no difference in breadth of service 

delivery. It was determined that impact would be 

minimal while still allowing the study to isolate 

program effect for one and two years of service 

dosage. 

NCPC also decided to eliminate the following 

series of questions on social-emotional 

development: 

• What is the impact of Shape NC on the 

physical and social-emotional development 

of participating children relative to children 

in comparison sites? 
Shape NC Evaluation Report: Final Report

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New Question 2: What is the impact of Shape NC 

TA on the physical activity of children in participating 

childcare sites receiving 1 or 2 years of treatment 

relative to children in comparison sites?

Westat compared outcomes among sites and among 

children enrolled in sites receiving Shape NC TA 

(treatment group) with outcomes among sites and 

children enrolled at matched comparison sites that 

had not yet received Shape NC TA (comparison 

group).

Measures

Site Level

Site director survey. To measure site-level outcomes, 

Westat adapted a subset of items from the Child Care 

Nutrition and Physical Activity Assessment Survey 

(Rudd Center for Food Policy and Obesity, 2008) to 

measure sites’ physical activity and nutrition policies 

and practices. This self-report survey has been used in 

modified form to describe nutrition environments in 

childcare sites (Gerritsen, Wall, & Morton, 2016) and 

has established psychometric properties, as required 

by request for proposals. Westat included items 

from each of the four areas covered by the measure: 

Nutrition (15 items); Physical Activity Environment (10 

items); Nutrition and Physical Activity Policies (6 

items); and Barriers to Promoting a Healthy Child 

Care Environment (15 items). Items were scored using 

multipoint scales and checklists. Henderson et al. 

(2011) conducted a validation study that compared 

survey items to interview or observation data, and 

the agreement of the items used for the evaluation 

ranged from 54.5 to 96.9. For items with low 

agreement (less than .70), Westat included interview 

questions to corroborate survey data. Due to the time 

required to collect fall 2017 baseline data, instead of

administering a second survey just a few months

It is also important to note that in year 1 the evaluation 

team collected and analyzed data on children’s food 

and physical activity preferences to examine children’s 

attitudes toward healthy eating and physical activities. 

These data were intended to answer the second 

research question. Based on four rounds of interviews 

with children enrolled in participating childcare 

sites (fall 2017, spring 2018, fall 2018, and spring 

2019) and discussions with NCPC, Westat concluded 

interview data were not sufficiently sensitive or 

informative as a child-level outcome measure and 

discontinued the collection of these data after spring 

2019. Although levels of child and parent agreement 

suggested young children can respond reliably, 

baseline responses were near the top of the response 

scale, limiting opportunities to detect significant 

changes in attitudes. As such, this report does not 

address the original question. Instead, the evaluation 

team investigated the impact of Shape NC TA on 

children’s physical activity at the site-level after 1 or 2 

years of treatment and answered this question using 

site-level outcome data:

How does this effect vary over time? What is the 

impact on physical and social-emotional development 

at the time the child is ready to enter kindergarten? 

NC Pre K requires classrooms to measure 

developmental progression among participating 

students. Shape NC had planned to use secondary 

data on children’s developmental progress collected 

in participating NC Pre K classrooms to measure this 

outcome. However, the program team concluded that 

a small number of NC Pre K classrooms participating 

in Shape NC were not using the same measurement 

tools to measure social-emotional health. As a result, 

there would not be sufficient data to measure 

outcomes, thus, the evaluation no longer addressed 

this research question. 
Shape NC Evaluation Report: Final Report

7 

Westat discontinued parent surveys after year 1. 

Instead, Westat asked parents to provide 

demographic data when requesting consent for their 

child to participate in the evaluation.

Child Height and Weight. Westat used children’s 

height and weight measurements to calculate each 

child’s BMI. BMI is a measure of body fat in relation 

to height and is frequently used to measure healthy 

weight in children (Henderson et al., 2011; Ogden, 

Carroll, Fryar, & Flegal, 2015). We used 

standardized charts developed by the National 

Center for Health Statistics to determine the 

percentage of children in different weight categories 

by comparing children’s BMI by age to commonly 

used national norms. 

Weight categories provided by this measure are 

underweight, healthy weight, overweight, and obese.

Response Rates

Table 1 contains information on the response rate for 

each data source.

Site director interview. During fall 2017 and spring 

2018 data collection periods, site directors answered 

questions about implementing Shape NC programs 

(e.g., changes to food and activity policies, and 

indoor and outdoor environments and equipment; 

challenges to promoting health and nutrition). To 

reduce respondent burden, Instead of conducting site 

director interviews in years 2 and 3, selected interview 

questions were included in the site director survey 

administered each spring.

Child Level

Parent survey. Westat used baseline survey 

responses to obtain child demographic data (race, 

ethnicity, gender, date of birth) and to corroborate 

children’s food preferences and activity habits. Due 

to low response rates, 

later, Westat collected year 1 outcome data using 

responses to relevant questions incorporated as part 

of the spring 2018 site director interview.

NOTE: The total number of eligible respondents represents the total number of children ages 2-4 whose parents returned a signed 

consent form and were enrolled at the site when data were collected, directors from participating sites, technical assistance 

providers, and parents of children who were eligible for participation. Parents who did not complete a parent survey were asked to

complete the parent demographic survey.
Shape NC Evaluation Report: Final Report

8 

3 Baseline Equivalence of Treatment 

and Comparison Groups

This section provides an overview of how Westat established that treatment and 

comparison groups were comparable when baseline data were collected. This 

ensures that differences in outcomes are more likely due to the intervention than to 

site or child characteristics.

Baseline equivalence was examined at the domain 

level. That is, the evaluation team established sitelevel equivalence by examining index scores that 

were used for site recruitment and site directors’ 

pooled responses related to a range of policy and 

practice outcomes that may or may not be targeted 

for improvement by Shape NC TA. To establish child 

level equivalence, the evaluation team examined 

BMI percentiles. First the evaluation team presents 

results of site-level equivalence tests followed by 

results of child-level equivalence tests followed by 

descriptive information for key characteristics of sites 

and children in both groups. Appendix D provides 

additional details about site-level and child-level 

baseline equivalence testing. Since the impacts of the program are estimated by 

comparing the treatment and comparison groups 

after the program was implemented, it is important 

for the two groups to be comparable at baseline. 

Westat ran statistical tests for mean differences 

between the treatment group and the comparison 

group in their wellness policies and practices (e.g., 

food provided, physical activities promoted), and body 

mass index (BMI) measurements. It is important to 

keep in mind that the study uses a quasi-experimental 

delayed treatment design to examine site- and childlevel impacts of Shape NC Technical Assistance (TA) 

after 1 and 2 years of treatment. Through this design, 

each year Westat examined baseline equivalence 

between the 20 sites assigned to the treatment group 

and the 20 sites assigned to the comparison group.

Site Level Equivalence

Sites in each group were statistically similar 

regarding baseline wellness outcomes (Y1: t 

= 1.435, p > 0.05, Y2: t = 0.38, p > 0.05).2 This 

finding indicates that Westat’s strategy of creating 

blocks of similar sites and providing subgrantees with 

recruitment instructions resulted in creating equivalent 

groups. For supplemental details about baseline 

equivalence testing, see Appendix D.

In the section below, the evaluation team summarized 

additional descriptive information about key policies, 

practices, and site characteristics at baseline to 

provide a clearer picture of existing wellness policies 

and practices in place at participating sites before 

implementing the program.

2 Please note Westat pooled 17 survey items regarding wellness policies and practices.
Shape NC Evaluation Report: Final Report

9 

Food and Beverage Policies

Baseline director surveys provided information about 

sites’ policies related to food and beverages prior to 

receiving Shape NC TA. At the time baseline data 

were collected, most sites in both groups had policies 

related to food and beverages (19 of 20 comparison 

sites and 19 of 20 treatment sites in year 1; and 18 of 

19 comparison sites and 20 of 20 treatment sites in 

year 2). Further, fewer than half of directors in each 

group indicated that their site’s policies exceeded 

USDA guidelines.

Some sites (6 of 20 comparison and 7 of 20 

comparison sites in year 1, and 3 of 19 comparison 

and 8 of 20 treatment sites in year 2) had policies 

regarding use of food as a reward for children’s 

behavior (e.g., getting a treat when children 

are quiet).

Figure 1. Number of sites with food and beverage policies

NOTE: Year one baseline results include cohort 1 treatment sites (n=20) and cohort 2 comparison sites (n=20). Year two baseline 

results include cohort 2 treatment sites (n=20) and cohort 3 comparison sites (n=19).

SOURCE: Director survey, fall 2017 (n=40) and fall 2018 (n=39).
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Physical Activity Policies

Most sites in the treatment and comparison 

groups had similar baseline policies related to 

physical activity at the beginning of years 1 

and 2. At baseline at almost all sites in both groups 

across both years, children had opportunities to play 

outdoors 5 days per week (among year 1 sites, 19 

of 20 treatment sites and all 20 comparison sites; 

among year 2 sites, all 20 treatment sites and all 

19 comparison sites). Similarly, the vast majority of 

sites in both groups had clear policies regarding 

physical activity at baseline (among year 1 sites, 17 

treatment and comparison sites; among year 2 sites, 

16 treatment sites and 14 comparison sites). Among 

year 1 sites, directors from 12 comparison sites (60%) 

and 13 treatment sites (65%) reported that children 

usually play outdoors for more than 60 minutes per 

day. Director survey results indicated that among 

year 2 sites, children at five treatment and eight 

comparison sites usually play outdoors for more than 

60 minutes per day.

In terms of physical activity practices, treatment 

and comparison sites were equivalent at 

baseline. Almost all site directors in both groups 

reported offering free play as an outdoor activity 

and frequently providing children with opportunities 

to dance, run, or jump to increase indoor physical 

activity. Slightly more treatment sites than comparison 

sites have small play equipment such as balls, hoops, 

or ropes that are accessible to children (among year 

1 sites, 13 treatment and 9 comparison sites; among 

year 2 sites, 15 treatment and 12 comparison sites) 

(Figure 2).

Figure 2. Number of sites with physical activity policies

NOTE: Year one baseline results include cohort 1 treatment sites (n=20) and cohort 2 comparison sites (n=20). Year two baseline 

results include cohort 2 treatment sites (n=20) and cohort 3 comparison sites (n=19).

SOURCE: Director interview, fall 2017 (n=40), director survey, fall 2018 (n=39).
Shape NC Evaluation Report: Final Report

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Site Characteristics Used to Create Indices

The evaluation team calculated a site index score to 

create blocks of similar sites. There were no significant 

differences between the sites in the treatment and 

comparison groups in the index score used for the 

recruitment (Y1, p > 0.05; Y2, p > 0.05).

Child-level Equivalence

Westat compared baseline differences in child-level 

outcomes and found no significant differences 

between children in the treatment and comparison 

groups (see Appendix D). Children in each group 

were statistically similar regarding baseline 

wellness outcomes (Y1: t = 0.82, p > 0.05, Y2: t = 

0.73, p > 0.05).

Descriptive child-level demographic data provided by 

sites for children’s age, gender, and race/ethnicity are 

provided in Figure 3. As the figure shows, children in 

the treatment and comparison groups share similar 

characteristics. A slightly larger proportion of children 

enrolled in treatment sites than comparison sites were 

Black (49.7% and 41.8%, respectively).
Shape NC Evaluation Report: Final Report

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Figure 3. Percentages of children in each group with key characteristics

NOTE: Percentages may not add to 100 percent due to parent responses indicating their child is a member of more than one race/

ethnicity category. Percentages are based on the imputed data.

SOURCE: Parent survey, fall 2017, and administrative data from sites, fall 2018
Shape NC Evaluation Report: Final Report

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Prior Exposure to Shape NC TA or Other 

Similar Programs

Despite efforts to limit recruitment to sites with no 

prior exposure to Shape NC resources (i.e., Be Active 

Kids® [BAK®], Nutrition and Physical Activity SelfAssessment for Child Care [Go NAPSACC], Natural 

Learning Initiative [NLI]), data indicate sites in each 

group had prior program exposure (Table 2). Based 

on director interviews, about half of directors in both 

treatment and comparison sites indicated at baseline 

(in fall 2017 and fall 2018) they were currently 

implementing or had previously implemented a 

Shape NC resource or program targeting similar 

outcomes. Some directors reported the exposure 

occurred 3 or more years prior to the study. Sites 

with prior exposure to NAPSACC (the predecessor to 

the online Go NAPSACC) implemented it between 

2011 and 2014. The comparison site that previously

implemented BAK® did so in 2014. One treatment 

site director reported prior experience with BAK® in 

2017, before beginning implementation in the fall of 

that year.

Examples of other programs sites implemented that 

focused on increasing physical activity or improving 

children’s nutrition prior to the start of this study 

include the Childcare Health Consultant Program 

(CCHC), Color Me Healthy, Kindermusik, Imagination 

Yoga, Wellness Works Wonders, and the Child and 

Adult Care Food Program (CACFP). Prior exposure 

to Shape NC resources or initiatives targeting 

similar outcomes is a nontrivial source of potential 

comparison group contamination. It is important 

to acknowledge that comparison sites had prior 

experience implementing wellness initiatives when 

interpreting results about the impact of Shape NC TA.

Table 2. Percentages of sites with previous health-related program experience

NOTE: Some sites had experience with multiple health-related programs, so numbers are not summed. Year one baseline results 

include cohort 1 treatment sites (n=20) and cohort 2 comparison sites (n=20). Year two baseline results include cohort 2 treatment 

sites (n=20) and cohort 3 comparison sites (n=19).

SOURCE: Director interview, fall 2017 and fall 2018.

Previous health-related program experience

Year one baseline 

(fall 2017)

Year two baseline 

(fall 2018)

Treatment 

(n=20)

Comparison 

(n=20)

Treatment 

(n=20)

Comparison 

(n=19)

Previous health-related program experience

Currently participating in any health-related programs 7 10 10 13

Not participating in any health-related programs 11 9 9 6

Previous exposure to Shape NC partner providers

NAPSACC or Go NAPSACC 2 2 2 1

Be Active Kids® (BAK®) 1 1 1 6

Preventing Obesity by Design (also known as NLI) 0 1 1 6

Engagement with other similar programs

Childcare Health Consultant Program (CCHC) 2 3 3 6

Kindermusik 1 1 1 0

Imagination Yoga 1 1 1 0

Wellness Works Wonders 0 1 1 0

Color Me Healthy 0 2 2 0
Shape NC Evaluation Report: Final Report

14

4 Impacts After 1 and 2 Years 

of Shape NC Implementation

This section includes a description of the analytic approach and a summary of 

site- and child-level impacts after 1 and 2 years of program implementation. The 

impacts described relate to best practices, some targeted by Shape NC TA for 

improvement and others that were not.

Analysis Approach

An overview of the questions, analytic approach and 

measures guiding the evaluation are provided in 

Table 3. Given the small number of treatment and 

comparison sites (i.e., less than 60), the evaluation 

team calculated the relationship between Shape NC 

Technical Assistance (TA) exposure and changes in

site-level wellness policies and practices using Fisher’s 

exact test (questions 1 and 2, Table 3). As mentioned 

earlier, the original question about children’s food 

and physical activity preferences was replaced with 

a question about physical activity at the site level 

instead. To highlight Shape NC TA impacts, the 

evaluation team described the findings in terms of 

statistically significant changes in childcare site policies 

and practices.

To assess impact of Shape NC TA on children’s 

body mass index (BMI) (question 3), the evaluation 

team conducted repeated measures of analysis 

of covariance, coupled with paired t-tests. This 

Difference-in-Difference (DID) approach enabled the 

evaluation team to examine differences in outcomes 

between groups, and simultaneously observe changes 

in outcomes over time within each dosage group 

(e.g., treatment group for 2 years, treatment group 

for 1 year, and comparison group).

To determine under which conditions Shape NC 

TA showed the most impact on children’s BMI, the

evaluation team used three-level nested hierarchical 

linear models (HLM), where level 1 = time, level 2 

= child, and level 3 = site to examine relationships 

among child outcomes, child demographic 

characteristics, and site characteristics.
Shape NC Evaluation Report: Final Report

15

Table 3. Impact questions, outcome measures, and analytic approach

1NOTE: Westat ran two separate HLM models – one with the child-level propensity score weights combined into a single ‘super

covariate’ and another with child demographic data entered as separate covariates. The super covariate was not significantly 

related to outcomes and did not provide interpretable information. In this report, the evaluation team focused on the findings from 

the latter model since it provided more interpretable information regarding child-level variables associated with changes in 

outcomes. Tables with HLM results (both models) are presented in Appendix E.

Impacts After 1 and 2 Years

Research Question 1: What is the impact of Shape 

NC technical assistance on the number of health and 

nutrition best practices implemented in participating 

childcare sites receiving 1 or 2 years of treatment 

relative to comparison sites?

There was no significant impact of Shape NC TA 

on the number of health and nutrition 

policies and best practices after 1 or 2 years of 

implementation. Most treatment and comparison 

sites had written policies related to food brought from 

home and staff consumption in front of children 

(Figure 4). However, of the 23 physical activity 

policies and practices examined for this study, 46 of 

them were already in state child care licensing 

regulations. Other policies didn’t align with the Shape 

NC implementation model; thus, it is not surprising 

that there were no statistically significant changes 

between baseline and followup. 

Question Outcome Measure Analytic Approach

1. What is the impact of Shape NC on the number of health

and nutrition best practices implemented in participating 

child care sites receiving one or two years of treatment 

relative to comparison sites?

• Site Director Survey 

Fall 2017

• Site Director Interview 

Fall 2017

• Site Director Interview 

Spring 2018

• Site Director Survey 

Fall 2018

• Site Director Survey 

Spring 2019

Fisher’s exact test

Two years of treatment 

(Cohort 1 only): N=20

One year of treatment 

(Year 1 Cohort 1 and Year 

2 Cohort 2 combined): 

N=40

Comparison (Year 1 

Cohort 2 and Year 2 

Cohort 3 combined): N=39

2. What is the impact of Shape NC on the physical activity of 

children in participating child care sites receiving one or two 

years of treatment relative to children in comparison sites?

3. What is the impact of Shape NC on the percentage of 

participating children at a healthy weight as measured by 

child body mass index (BMI) status relative to children in 

comparison sites?

• Change in child’s BMI 

percentile

• Change in child’s BMI 

weight category (i.e., 

underweight, healthy 

weight, overweight, or 

obese)

Repeated measures 

ANCOVA Paired t-tests

HLM11

(Two years of treatment: 

N=210, One year of 

treatment: N=910, 

Comparison: N=924)
Shape NC Evaluation Report: Final Report

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Figure 4. Changes to food and beverage policies from baseline to follow-up

NOTE: Findings for sites after two years of treatment include data from cohort 1 sites that received treatment in both years (Year 1

and Year 2). Findings for sites after one year of treatment include data from treatment sites in Year 1 (cohort 1) and Year 2 (cohort 2). 

Findings for comparison sites include data from the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCE: Director survey, fall 2017, fall 2018, and spring 2019; Director interview, spring 2018.

Research Question 2: What is the impact of Shape

NC technical assistance on the physical activity of 

children in participating childcare sites receiving 1 or 

2 years of treatment relative to physical activity of 

children in comparison sites?

Shape NC TA had a significant positive impact 

on the number and types of indoor and outdoor 

physical activities available to children at 

treatment sites. The impacts were more evident 

among the sites receiving 2 years of treatment.

Indoor activities

Data showed there were significant increases in sites 

offering indoor free play, structured play/organized 

games, balancing, and stretching (Figure 5).

• After 2 years, children at all 20 treatment sites 

(100%) engaged in indoor free play, an increase 

from one site (5%) at baseline (p < 0.01).
Shape NC Evaluation Report: Final Report

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• After 2 years, the number of sites in which children 

engaged in structured indoor play/organized games 

increased to 17 sites (85%) from 8 sites (40%) at 

baseline (p=0.01).

• After 2 years of treatment, the number of sites in 

which children engaged in indoor stretching 

increased to 16 (80%) from 4 (20%) at baseline (p 

< 0.01).

Figure 5. Changes in types of indoor physical activities between baseline and follow-up

* The percentage of sites at follow-up is statistically different from the percentage of sites at baseline (p < .05).

NOTE: Findings for sites after two years of treatment include data from cohort 1 sites that received treatment in both years (Year 1 and 

Year 2). Findings for sites after one year of treatment include data from treatment sites in Year 1 (cohort 1) and Year 2 (cohort 2). 

Findings for comparison sites include data from the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019.
Shape NC Evaluation Report: Final Report

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Outdoor activities

After 2 years, there were statistically significant 

increases in the number of sites in which outdoor 

structured play/organized games, cardiovascular 

exercise, play with loose toys, and balancing activities 

were available (Figure 6).

• After 2 years of treatment, the number of sites in 

which children participated in outdoor structured 

play/organized games increased from four (20%) at 

baseline to 17 (85%) (p < 0.01).

• The number of sites in which children engaged in 

outdoor cardiovascular exercise increased from 25 

(63%) at baseline to 31 (78%) after 1 year of 

treatment (p > 0.05), and from 8 (40%) at baseline 

to all 20 sites after 2 years of treatment (p < 0.01).

• Among sites that received 2 years of treatment, the 

number in which children played/built with loose 

toys outdoors increased from 15 at baseline to all 

20 sites (p=0.05).

• Among sites that received 2 years of treatment, 

the number of sites in which children engaged in 

outdoor balancing activities increased from 

five sites at baseline to 14 (p=0.01). The number 

of sites in which children engaged in outdoor 

balancing activities among sites that received 1 year 

of treatment (n=19, 48%) remained unchanged, 

as did the number of comparison group sites in 

which children engaged in these types of activities 

(n=15, 38%).

After 2 years of treatment

the percentage of sites in which children 

participated in outdoor structured play/ 

organized games increased to

85%from 20%

at baseline.
Shape NC Evaluation Report: Final Report

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Figure 6. Changes in types of outdoor physical activities between baseline and follow-up

* The percentage of sites at follow-up is statistically different from the percentage of sites at baseline (p < .05).

NOTE: Findings for sites after two years of treatment include data from cohort 1 sites that received treatment in both years (Year 1 and 

Year 2). Findings for sites after one year of treatment include data from treatment sites in Year 1 (cohort 1) and Year 2 (cohort 2). 

Findings for comparison sites include data from the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019.
Shape NC Evaluation Report: Final Report

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• Younger children, on average, were significantly 

more likely than older children to maintain a healthy 

weight (p < 0.01).3

• After 2 years of treatment, the percentage of 

children in the healthy weight category decreased 

significantly from 73.8 percent at baseline to 65.7 

percent (p=0.02) while the percentage of children in 

the obese category increased significantly from 9.5 

percent at baseline to 15.2 percent (p=0.02).

• After 1 year of treatment 

• the percentage of children in the healthy weight 

category increased significantly from 68.4 

percent at baseline to 71.1 percent (p=0.03). 

However, children in the comparison group, had 

similar gains, among the percentage of children 

in the healthy weight category, which increased 

from 70.8 percent to 73.9 percent (p=0.02) 

after 1 year.

• the percentage of children in the obese 

category decreased significantly from 12.7 

percent at baseline to 10.7 percent (p=0.02). 

However, comparison group sites had similar 

decreases in the percentage of children in the 

obese category, which declined from 11.3 

percent to 8.8 percent (p=0.03).

Research Question 3: What is the impact of

Shape NC technical assistance on the percentage of 

participating children at a healthy weight as measured 

by child body mass index (BMI) status relative to 

children in comparison sites?

Difference between treatment 

and comparison groups

Shape NC TA did not have a significant impact 

on the percentage of participating children 

at a healthy weight. More than two-thirds of 

children in both treatment and comparison groups 

were in the healthy weight category 

at baseline and most children in both groups 

stayed in the healthy weight category after 1 or 

2 years of treatment. Additionally, comparison sites, 

on average, had a significantly higher proportion of 

children at a healthy weight (p=0.04) (Figure 7).

Changes within each dosage group

The section below provides the noteworthy changes 

between baseline and follow up within each dosage 

group (e.g., received treatment for 2 years compared 

to baseline, received treatment for 1 year and 

compared to a separate comparison group). Findings 

from HLM analysis are provided where applicable to 

highlight statistically significant relationships between 

the treatment and child demographic variables.

3 To avoid overfitting the model with the binary outcome, the relationships were examined with two-level HLM including 

child-level covariates.

After one year of treatment, the 

average BMI percentile decreased 

significantly for children who 

were in the obese and overweight 

categories at baseline.
Shape NC Evaluation Report: Final Report

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Figure 7. Percentage of children in BMI weight categories between baseline and follow-up

* The percentage of children at follow-up is statistically different from the percentage of children at baseline (p < .05).

NOTE: Findings for children that received two years of treatment include data from children in cohort 1 that received treatment in 

Year 1 and Year 2. Findings for children that received one year of treatment include data from children at the treatment sites in

Year 1 (cohort 1) and Year 2 (cohort 2). Findings for children in the comparison group include data from children at the comparison 

sites in Year 1 (cohort 2) and Year 2 (cohort 3).

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019.

The evaluation team also examined children’s BMI

percentile changes in each of the four weight 

categories (i.e., obese, overweight, healthy weight, 

and underweight), as determined by children’s 

baseline BMI. To interpret whether a BMI change 

is positive or negative, the relative direction of the 

change must be considered (e.g., children who move 

from underweight category at baseline and to the 

healthy weight category at followup vs. children who 

move from the overweight category at baseline to the 

obese category at followup).4 Table 4 presents the 

number of children in each weight category by 

number of years of program exposure.

4 The relationships were examined with three-level HLM with both site-level and child-level covariates.
Shape NC Evaluation Report: Final Report

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Table 4. Number of children in each weight category

NOTE: Data for children that received 2 years of treatment includes cohort 1 only. Data for children that received 1 year of treatment 

includes cohorts 1 and 2 combined. Data for children in the comparison group includes Year 1 cohort 2 and Year 2 cohort 3.

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019.

• After 2 years of treatment, the average BMI 

percentile decreased among the 20 children 

who were obese at baseline (from 20.3 at 

baseline to 19.6). However, the decline was not 

statistically significant (p > 0.05). Additionally, 

15 percent (3 children) moved to the overweight 

category and 25 percent (5 children) moved to the 

healthy weight category.

• Among the 104 children in the obese category in 

the comparison group, the average BMI percentile 

decreased significantly at follow up (from 20.1 at 

baseline to 19.4) (p < 0.01). Data showed that 26 

percent (27 children) moved to the overweight 

category and 8 percent (8 children) moved to the 

healthy weight category.

There was no statistically significant difference 

in the rate of change between children in 

treatment and comparison groups (beta = 0.00, 

p > 0.05). Although children in each group did 

change weight categories, rates were similar for 

children in both groups. In examining each weight 

category, most changes were positive (i.e., movement 

from obese to overweight or healthy weight, from 

overweight to healthy weight, or from underweight 

to healthy weight).

The section below summarizes noteworthy changes in 

BMI percentile between baseline and follow up within 

each dosage group (e.g., received treatment for 2 

years, received treatment for 1 year, or comparison 

group). Additional descriptive data highlight 

movement between weight categories (Table 5).

Key findings for children in the obese category at 

baseline:

• After 1 year of treatment, the average BMI 

percentile decreased significantly (from 20.0 at 

baseline to 19.3) (p < 0.01). Among children in this 

dosage group (n=116), 27 percent (31 children) 

moved to the overweight category and 7 percent (9 

children) moved to the healthy weight category. 

Key findings for children in the overweight 

category at baseline:

• After 1 year of treatment, there were 

statistically significant decreases in the average 

BMI percentile (from 17.7 at baseline to 17.3) 

(p < 0.01). That is, among the 134 children in the 

overweight category at baseline, 40 percent (54 

children) moved to the healthy weight category.

• After 2 years of treatment, the average BMI 

percentile among children in this dosage group 

(28 children) decreased significantly from 18.1 

to 17.5 (p=0.04). Three percent (9 children) moved 

to the healthy weight category.

Weight category Received 2 years of treatment 

(n=210)

Received 1 year of treatment 

(n=910)

Comparison 

(n=924)

Obese 20 116 104

Overweight 28 134 129

Healthy weight 155 622 654

Underweight 7 38 37
Shape NC Evaluation Report: Final Report

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• Among the 129 children in the comparison 

group, the average BMI percentile decreased 

significantly from 17.7 at baseline to 17.2 at 

followup (p < 0.01). Data showed that 49 percent 

(64 children) moved to the healthy weight category 

at followup.

Key findings for children in underweight 

category at baseline:

• After 1 year of treatment, there were 

significant increases in the average BMI 

percentile for 38 children in this category from 

13.5 at baseline to 13.9 (p < 0.01). Among the 38 

children in the underweight category at baseline, 39 

percent (17 children) moved to the healthy weight 

category at followup.

• Among the 7 children that received 2 years of 

treatment, the average BMI decreased from 14.0 

at baseline to 14.1 after 2 years of treatment. 

However, the change was not 

statistically significant (p > 0.05). Additionally, three 

children moved to the healthy weight category.

• Among the 37 children in the comparison 

group, the average BMI percentile increased 

statistically significantly from 13.5 at baseline 

to 14.3 at followup (p < 0.01). Data showed 

that 46 percent (17 children) moved to the healthy 

weight category.

Table 5. Children’s movement between BMI categories from baseline to follow-up

Children who received 2 years of treatment (n=210)

Children who received 1 year of treatment (n=910)

Comparison group children (n=924)

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019.

Weight Category at Baseline

Underweight 

(n=37)

Healthy Weight 

(n=654)

Overweight 

(n=129)

Obese 

(n=104)

Weight 

Category at 

Follow-up

Underweight 20 32 0 0

Healthy weight 17 594 64 8

Overweight 0 26 55 27

Obese 0 2 10 69

Weight Category at Baseline

Underweight 

(n=38)

Healthy Weight 

(n=622)

Overweight 

(n=134)

Obese 

(n=116)

Weight 

Category at 

Follow-up

Underweight 23 21 0 0

Healthy weight 15 549 54 9

Overweight 0 35 60 31

Obese 0 17 20 76

Weight Category at Baseline

Underweight 

(n=7)

Healthy Weight 

(n=155)

Overweight 

(n=28)

Obese 

(n=20)

Weight 

Category at 

Follow-up

Underweight 4 8 0 0

Healthy weight 3 121 9 5

Overweight 0 17 8 3

Obese 0 9 11 12
Shape NC Evaluation Report: Final Report

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5 Conclusions and Lessons Learned

This section summarizes key findings relevant to the multi-year impact study

of Shape NC TA on participating childcare sites and children. It also includes a 

discussion of study limitations and lessons learned.

The evaluation team planned to collect child height 

and weight data for 3 consecutive years from 

children enrolled at participating childcare sites. 

Due to COVID-19 physical distance guidelines, inperson data collection restrictions, and childcare site 

closures, spring 2020 data collection was cancelled. 

Although Westat was unable to estimate the impact 

of Shape NC Technical Assistance (TA) after 3 years 

of support, it used data collected during the first 

2 years of the program to evaluate the child-level 

outcomes of Shape NC TA after 2 years (instead of 3). 

However, because of the large amount of missing 

implementation data in year 2, especially Nutrition and 

Physical Activity Self-Assessment for Child 

Care (Go NAP SACC) data, Westat was not able to 

conduct planned implementation analysis or generate 

evidence about that program’s contributions to results 

summarized in this report.

In addition to disruptions caused by COVID-19, a 

combination of ceiling and testing effects led Westat 

to discontinue direct collection with 2-year-old 

children on their food and activity preferences using 

the interview protocol. This change eliminated the 

opportunity to examine whether evidence indicated 

Shape NC TA produced short-term outcomes (attitude 

changes) at the child-level, leaving the less sensitive 

body mass index (BMI) outcome as the sole child-level 

outcome measure. Finally, given the relatively small 

number of sites in the sample, the evaluation lacks 

the power to detect small program effects.

The evaluation did not find evidence suggesting 

Shape NC TA affects the percentage of participating 

children at a healthy weight as measured by BMI. 

However, the evaluation generated rigorous evidence 

that Shape NC TA had a statistically significant positive 

impact on the number and types of opportunities 

for indoor and outdoor physical activity offered to 

children at participating sites, especially after 2 years. 

Findings suggest both the Be Active Kids® (BAK®) 

and Natural Learning Initiative (NLI) are powerful and

effective interventions for increasing opportunities for 

children to engage in physical activity both indoors and 

outdoors while receiving site-based care. Despite prior 

exposure to programs with similar goals among sites 

in both groups, evidence indicates Shape NC

TA produced large and significant improvements in 

opportunities for indoor and outdoor physical activity 

among children at participating childcare sites.

Lessons Learned 

NCPC learned two key lessons from this last phase of 

Shape NC. Participants learned the importance of 

community engagement to support the project such as 

donation of materials, time and funding. Center 

directors learned how to make the “ask” to secure 

needed resources. This skill will be utilized in the 

future to sustain the progress and support continued 

growth at Shape NC centers. Another important 

lesson learned is that Shape NC is a model better 

suited to achieve promising outcomes at the centerlevel. The crux of the Shape NC model is information 

dissemination through intensive learning opportunities: 

the Provider and Technical Assistance Collaboratives, 

the Shape NC Summit, and the Shape NC track at the 

National Smart Start Conference. All training 

opportunities are supported by coaching and technical 

assistance to embed learned best practices. 

With Shape NC sunsetting in 2021, NCPC will scale 

coaching and TA across the Smart Start network 

through a project called Beyond Shape: Coaching for 

Technical Assistants. The goal of Beyond Shape is to 

support the 150 technical assistants in the Smart Start 

network via coaching toward new and enhanced 

policies, collaborations, and environments that will 

influence a wide range of child and family outcomes. 

NCPC will facilitate individual professional growth and 

convene professional learning communities and will 

curate and create content that expands competencies 

for mentoring, coaching, and consultation in child 

care. 
25

Shape NC Evaluation Report: Final Report

References

Alkon, A., Crowley, A., Benjamin-Neelon, S., Hill, S., 

Pan, Y., Nguyen, V., Rose, R., Savage, E., Forestieri, N., 

Shipman, L., & Kotch, J. (2014). Nutrition and physical 

activity randomized control trial in child care centers 

improves knowledge, policies, and children’s body 

mass index. BMC Public Health, 14:215, http://www.

biomedcentral.com/1471-2458/14/215.

Asigbee, F.M., Whitney, S.D., & Peterson, C.E. (2018). 

The link between nutrition and physical activity in 

increasing academic achievement. Journal of School 

Health, 88, 407-415.

Battista, R., Oakley, H., Weddell, M., Mudd, L., 

Greene, J., & West, S. (2014). Improving the physical 

activity and nutrition environment through selfassessment (NAP SACC) in rural area child care 

centers in North Carolina. Preventive Medicine, 67, 

http://dx.doi.org/10.1016/j.ypmed.2014.01.022.

Benjamin, S., Neelon, B., Ball, S., Bangdiwala, S., 

Ammerman, A., & Ward, D. (2007). Reliability 

and validity of a nutrition and physical activity 

environmental self-assessment for child care. 

International Journal of Behavioral Nutrition and 

Physical Activity, 4(29).

Bruner, C. (2011). A framework for state leadership 

and action in building the components of an early 

childhood system. Retrieved from BUILD initiative 

website: http://www.buildinitiative.org/Portals/0/

Uploads/Documents/Four_Ovals_paper.pdf.

Buuren, Stef van (2018). Flexible imputation of missing 

data (2nd ed.). Boca Raton, FL: CRC Press.

Centers for Disease Control and Prevention. (2010). 

The association between school based physical 

activity, including physical education, and academic 

performance. Atlanta, GA: U.S. Department of Health 

and Human Services.

Cheung, P.C., Cunningham, S.A., Naryan, K.M.V., & 

Kramer, M.R. (2016). Childhood obesity incidence in 

the United States: A systematic review. Childhood 

Obesity, 12, 1-11.

Chiang, R. J., Meagher, W., & Slade, S. (2015). How 

the whole school, whole community, whole child 

model works: Creating greater alignment integration, 

and collaboration between health and education.

Journal of School Health, 85, 775-784.

Cosco, N., Moore, R., & Islam, M. (2010). Behavior 

mapping: A method for linking preschool physical 

activity and outdoor design. Medicine and Science in 

Sports and Exercise, 42(3), 513–519.

Datar, A., & Chung, P. (2015). Changes in 

socioeconomic, racial/ethnic, and sex disparities in 

childhood obesity at school entry in the United States. 

JAMA Pediatrics, 169(7), 696-697.

Datar, A., & Sturm, R. (2006). Childhood overweight 

and elementary school outcomes. International 

Journal of Obesity, 30(9), 1449-1460.

Davis, C. L., & Cooper, S. (2011). Fitness, fatness, 

cognition, behavior, and academic achievement 

among overweight children: do cross-sectional 

associations correspond to exercise trial outcomes? 

Preventive Medicine, 52, S65-S69.

De Marco, A. D., & De Marco, M. (2016). Shape 

NC phase II evaluation year 2 report. Retrieved 

from http://www.smartstart.org/wp-content/

uploads/2016/10/ShapeNC-Evaluation-Report-2016. 

pdf.

De Marco, A., Zeisel, S., & Odom, S. (2014): An 

evaluation of a program to increase physical activity 

for young children in child care. Early Education and 

Development,

DOI: 10.1080/10409289.2014.932237.

Dietz, W. H. (1998). Childhood weight affects adult 

morbidity and mortality. Journal of Nutrition, 128, 

411S-414S.

Dunn, C., Thomas, C., Smith, C., & Pegram, L. 

(2001). Be active kids: A nutrition and physical activity 

education program for four- and five-year-olds. The 

Forum for Family and Consumer Issues, 6(3).

Ebbeling, C. B., Pawlak, D. B., & Ludwig, D. S. (2002). 

Childhood obesity: Public-health crisis, common sense 

cure. The Lancet, 360, 473-482.
26

Shape NC Evaluation Report: Final Report

Fedewa, A. L., & Ahn, S. (2011). The effects of 

physical activity and physical fitness on children’s 

achievement and cognitive outcomes: A metaanalysis. Research Quarterly for Exercise and Sport, 

82(3), 521-535.

Gerritsen, S., Wall, C., & Morton, S. (2016). Childcare nutrition environments: Results from a survey of 

policy and practice in New Zealand early childhood 

education services. Public Health Nutrition, 19(9), 

1531-1542. Doi:10.1017/S1368980015002955.

Gortmaker, S. L., Must, A., Perrin, J. M., Sobol, A. 

M., & Dietz, W. H. (1993). Social and economic 

consequences of overweight in adolescence and 

young adulthood. New England Journal of Medicine, 

329(14), 1008-1012.

Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, 

C. L. (2017). Prevalence of obesity among adults and 

youth: United States, 2015-2016 (NCHS Data Brief 

288). Hyattsville, MD: National Center for Health 

Statistics.

Henderson, K. E., Grode, G. M., Middleton, A. E., 

Kenney, E. L., Falbe, J., & Schwartz, M. B. (2011). 

Validity of a measure to assess the child-care nutrition 

and physical activity environment. Journal of the 

American Dietetic Association, 111, 1306-1313.

Lauby-Secretan, B., Scoccianti, C., Loomis, D., 

Grosse, Y., Bianchini, F., & Straif, K. (2016). Body 

fatness and cancer: Viewpoint of the IARC working 

group. New England Journal of Medicine, 375(8), 

794-798.

Lee, H., Andrew, M., Gebremariam, A., Lumeng, 

J. C., & Lee, J. M. (2014). Longitudinal associations 

between poverty and obesity from birth through 

adolescence. American Journal of Public Health, 

104(5), e70-76.

Lewallen, T. C., Hunt, H., Potts-Datema, W., Zaza, 

S., & Giles, W. (2015). The whole school, whole 

community, whole child model: A new approach for 

improving educational attainment and healthy 

development for students. Journal of School Health, 

85(11), 729-739.

Lumeng, J., Kaciroti, N., Sturza, J., Krusky, A., Miller, 

A., Peterson, K., Lipton, R., & Reischl, T. (2015). 

Changes in body mass index associated with head 

start participation. Pediatrics, 135(2), DOI: 10.1542/ 

peds.2014-1725

Moore, L. L., Lombardi, D. A., White, M. J., Campbell, 

J. L., Oliveria, S. A., & Ellison, R. C. (1991). Influence 

of parents’ physical activity levels on activity levels of 

young children. The Journal of Pediatrics, 118(2), 

215-219.

North Carolina Department of Health and Human 

Services (NCDHHS), Division of Child Development 

and Early Education (2017). NC child care snapshot. 

Retrieved from https://ncchildcare.ncdhhs.gov/County/ 

Child-Care-Snapshot.

Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. 

M. (2015). Prevalence of obesity among adults and 

youth: United States, 2011-2014 (NCHS Data Brief 

219). Washington, DC: U.S. Department of Health and 

Human Services, Centers for Disease Control and 

Prevention, National Center for Health Statistics.

Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, 

C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. 

(2016). Trends in obesity prevalence among children 

and adolescents in the United States, 1988-1994 

through 2013-2014. Journal of the American Medical 

Association, 315(21), 2292-2299.

Pan, L., Blanck, H.M., Park, S., Galuska, D.A., 

Freedman, D.S., Potter, A., et al. (2019). State-specific 

prevalence of obesity among children aged 2–4 years 

enrolled in the special supplemental nutrition program 

for Women, Infants, and Children — United States, 

2010–2016. Morbidity and Mortality Weekly Report, 

68, 1057-1061.

Pulgaron, E. R. (2013). Childhood obesity: A review 

of increased risk for physical and psychological comorbidities. Clinical Therapy, 35(1), 1-21.

Rampersaud, G. C., Pereira, M. A., Girard, B. L., 

Adams, J., & Metzl, J. D. (2005). Breakfast habits, 

nutritional status, body weight, and academic 

performance in children and adolescents. Journal of 

the American Dietetic Association, 105(5), 743-760.
27

Shape NC Evaluation Report: Final Report

Rudd Center for Food Policy and Obesity. (2008). 

Child care nutrition and physical activity assessment 

survey. Retrieved from http://www.uconnruddcenter. 

org/files/Pdfs/ChildCareDirectorSurvey.pdf.

Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). 

Experimental and quasi-experimental designs for 

generalized causal inference. Boston, MA: Houghton 

Mifflin.

Shore, S. M., Sachs, M. L., Lidicker, J. R., Brett, S. 

N., Wright, A. R., & Libonati, J. R. (2008). Decreased 

scholastic achievement in overweight middle school 

students. Obesity, 16(7), 1535-1538.

Simmonds, M., Llewellyn, A., Owen, C. G., & 

Woolacott, N. (2016). Predicting adult obesity from 

childhood obesity: a systematic review and meta‐

analysis. Obesity Reviews, 17(2), 95-107.

Singh, G. K., Siahpush, M., & Kogan, M. D. (2010). 

Rising social inequalities in U.S. childhood obesity, 

2003–2007. Annals of Epidemiology, 20(1), 40-52.

Singh, G., Danaei G., Farzadfar, F., Stevens, G., 

Woodward M., Wormser, et al. (2013). The agespecific quantitative effects of metabolic risk factors 

on cardiovascular diseases and diabetes: A pooled 

analysis. PLOS ONE, 8(7): e65174. doi:10.1371/ 

journal.pone.0065174

Skinner, J. D., Carruth, B. R., Bounds, W., & Ziegler, P.

J. (2002). children’s food preferences: A longitudinal 

analysis. Journal of the American Dietetic Association, 

102(11), 1638-1647.

Smith, W., Moore, R., Cosco, N., Wesoloski, 

J., Danninger, T., Ward, D., et al. (2014). 

Increasing physical activity in childcare outdoor 

learning built environment and social factors 

environments: The effect of setting adjacency 

relative to other. Environment and Behavior, DOI: 

10.1177/0013916514551048.

Trust for America’s Health and the Robert Wood 

Johnson Foundation. (2016). The state of obesity. 

Retrieved from http://stateofobesity.org/adult-obesity/.

United States Census Bureau (2019). Quick facts 

North Carolina. Retrieved from http://www.census. 

gov/quickfacts/table/PST045215/37.

Vaughn, A. (2013). Shape NC annual report. Retrieved 

from http://www.smartstart.org/wp-content/

uploads/2013/04/Shape-NC-Annual-Report-2012_ 

FINAL.pdf.

Volger, S., Radler, D.R., & Rothpletz-Puglia, P. (2018). 

Early childhood obesity prevention efforts through a 

life course health development perspective: A scoping 

review. PLoS ONE, 13, 1-24.

Wang., Y, Wu, Y., Wilson, R., Bleich, S., Cheskin, 

L., Weston, C., et al. (2013). Childhood obesity 

prevention programs: comparative effectiveness 

review and meta-analysis. Comparative Effectiveness 

Review No. 115. (Prepared by the Johns Hopkins 

University Evidence-based Practice Center under 

Contract No. 290-2007-10061-I.) AHRQ Publication 

No. 13-EHC081-EF. Rockville, MD: Agency for 

Healthcare Research & Quality, 

www.effectivehealthcare.ahrq.gov/reports/final.cfm.
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Shape NC Evaluation Report: Final Report

Appendix A.

Imputation

This appendix provides the theory of change and logic model for Shape NC 

Technical Assistance (TA), and outlines data collection methods and instruments 

used to address questions guiding the study.

Program Theory and Logic Model

The program theory supporting Shape NC TA is that 

TA, coaching and training, and the combined use of 

best practices related to infant and child nutrition, 

physical activity, and outdoor play and learning (i.e., 

Nutrition and Physical Activity Self-Assessment for 

Child Care [Go NAP SACC], Be Active Kids® [BAK®], 

and Natural Learning Initiative [NLI]) lead to increased 

use of site-level best practices and improvements 

in children’s attitudes toward healthy nutrition and 

physical activity. Ultimately, these changes lead to 

increases the proportion of children at a healthy 

weight. The Shape NC TA logic model (Exhibit 

A-1) shows the program relies on funding from the 

Corporation for National Community Service 

(CNCS) and the Blue Cross Blue Shield of North 

Carolina Foundation (BCBSNCF). Other inputs include 

dedicated time from key NCPC staff, materials and 

expertise from partner providers (Go NAPSACC, 

BAK®, and NLI), and support from Shape NC mentor 

sites that demonstrate and share with new sites what 

they learned from receiving Shape NC TA previously.5

In addition to findings from past evaluations of Shape 

NC TA, research supports use of specific program 

components. For example, the Go NAPSACC program 

has been shown to improve provider and parent 

knowledge of nutrition and physical activity and site 

health policies, as well as improve children’s body 

mass index (BMI) (Alkon et al., 2014; Battista et al., 

2014; Benjamin et al., 2007). The BAK® program has 

been shown to improve children’s nutrition, increase 

children’s knowledge of the importance of proper 

nutrition and physical activity, increase

physical activity, and decrease screen time (e.g., time 

spent watching videos and playing video games) 

(DeMarco, Zeisel, & Odom, 2014; Dunn, Thomas, 

Smith, & Pegram, 2001; Smith et al., 2014). Research 

supports the effectiveness of NLI’s outdoor designs for 

increasing physical activity (Cosco, Moore, & Islam, 

2010). Taken together, evidence suggests using these 

programs, which support Shape NC programs, can 

improve the health environment in childcare settings 

and related child-level outcomes. However, this is 

the first time a rigorous evaluation of the combined 

effects of using these programs has been conducted.

As shown in the logic model (Exhibit A-1), staff from 

North Carolina Partnership for Children (NCPC) 

provide coaching and TA to subgrantee staff who 

support implementation and completion of Go NAP 

SACC at participating childcare sites and provide 

training on using the BAK® curriculum. Staff from 

NLI work directly with subgrantees and with sites to 

design and implement site-specific improvements. 

In the short term, these activities are expected 

to improve site staff knowledge and use of best 

practices related to young children’s nutrition and 

physical activity, and improve children’s attitudes 

toward nutritious foods and being active. After 3 to 5 

years, sites are expected to increase their use of 

best practices to support healthy nutrition and 

physical activity with the ultimate long-term outcome 

of more children at a healthy weight, as indicated by 

children’s BMI scores.

Table A-1 shows the research questions and data 

sources we used to answer the questions guiding 

the impact evaluation.

5 Although Carolina Global Breastfeeding Institute’s breastfeeding program is included in the Shape NC logic model, it is not part 

of Westat’s evaluation.
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Shape NC Evaluation Report: Final Report

Exhibit A-1. Shape NC logic model
30

Shape NC Evaluation Report: Final Report

Table A-1. Data sources used to address impact questions

NOTE: Site director interviews were conducted in year 1 only (fall 2017 and spring 2018).

Questions Site director 

survey

Site director 

interview

Child height 

and weight

Years 1-2 Years 1 Years 1-2

What is the impact of Shape NC on the number of health and nutrition 

best practices implemented in participating child care sites receiving 

one or two years of treatment relative to comparison sites? 

What is the impact of Shape NC on the physical activity of children in 

participating child care sites receiving one or two years of treatment 

relative to children in comparison sites? 

What is the impact of Shape NC on the percentage of participating 

children at a healthy weight as measured by child body mass index 

(BMI) status relative to children in comparison sites? 
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Shape NC Evaluation Report: Final Report

Appendix B.

Methodology

This appendix describes key elements of the impact study design and the process 

the evaluation team used to create comparable groups of treatment and 

comparison sites over time, and key analytic details.

Impact Study

Study Design

Westat conducted a mixed methods evaluation using 

a quasi-experimental delayed treatment design to 

examine site- and child-level impacts of Shape NC TA 

after 1 and 2 years of exposure.6 Westat compared 

outcomes among sites and among children enrolled 

in sites receiving Shape NC TA (treatment group) 

with outcomes among sites and children enrolled at 

matched comparison sites that did not receive Shape 

NC TA (comparison group).

Matching of Treatment and Comparison Groups 

Site-Level. There were 709 childcare sites located 

across the four participating counties at the start of 

the study. To ensure that treatment and comparison 

sites are comparable across all years, the evaluation 

team grouped sites within each county into three 

blocks based on characteristics subgrantees (with 

lived experience) believed to be associated with site 

readiness to implement the program. Then, to ensure 

subgrantees did not select all the most prepared sites 

to receive Shape NC TA in the early years, leaving 

only the less prepared sites for the comparison group 

in later years, Westat provided subgrantees with 

detailed instructions regarding how many pairs of 

sites to recruit from each block in year 1. Once pairs 

of sites were recruited, subgrantees designated which 

site within each pair would receive Shape NC TA 

services and which site would be part of the year 1 

comparison group. In year 2, subgrantees recruited 

new sites to participate in the study as the new 

comparison group, replacing year 1 comparison sites

that started receiving treatment. Westat used this 

approach to allow subgrantees the freedom to recruit 

and assign sites based on their deep knowledge of 

sites within their county while reducing the chances 

that treatment and comparison groups would not be 

equivalent, especially in year 2. Westat created blocks 

by calculating an index score for each site using the 

following five measures from the North Carolina 

Department of Health and Human Services’ Division 

of Child Development and Early Education (2017), 

and our discussions with NCPC and each subgrantee 

regarding which characteristics they thought were 

most associated with site readiness to participate fully 

in the program:

1.

2.

Quality license level (teacher education level),

Instructional program quality (e.g., space, 

materials, cleanliness, staff-to-child ratio, and 

interactions between adults and children and 

among children),

Days in operation (number of days since the site 

opened),

Site size (number of children the site can serve), 

and

Subsidy status (percent of children receiving a 

subsidy).

3.

4.

5.

To create the index, the evaluation team calculated 

a normalized value (between 0 and 1) for each of 

the five measures for each site, so that each site 

had a total of five normalized values. The team then 

calculated a weighted index score by summing the 

normalized values for each site. Using the weighted

6 Due to state-mandated restrictions resulting from COVID-19, the evaluation team could not collect outcome data from children 

(height and weight) in year 3, as planned. Instead, the analysis reported here includes outcomes after 1 and 2 years.
32

Shape NC Evaluation Report: Final Report

index score, Westat identified sites that were similar 

with regard to key characteristics and formed three 

blocks of sites within each county. For example, within 

the first block, if Site A is recruited and assigned to the 

treatment group, it can be matched to comparison 

group Site B with a similar index score. Site B then 

serves as a proxy for what Site A would have 

experienced if Site A had not received the treatment.

This method offered two advantages. First, using index 

scores to match treatment and comparison sites 

prevents large differences between the two 

groups in the variables used to construct these scores. 

Second, because the evaluation team used index 

scores as a “super” covariate in the regression model, 

carrying information from all the covariates (e.g., child 

demographic variables) and their interaction terms, 

the approach used only one degree of freedom. Used 

this way, index scores increased statistical power 

compared to power when individual covariates are 

adjusted. Furthermore, combined use of index scores 

is more efficient and robust than when each score is 

used alone (Shadish, Cook, & Campbell, 2002).

Using this approach, Westat created blocks of 

sites within each county that had not previously 

implemented Shape NC programs and had similar 

index scores. Prior to the recruitment of year 1 sites, 

subgrantees reviewed the lists of sites within each 

block and confirmed that lists reflected distinct 

differences among groups’ regarding their readiness 

to receive Shape NC TA. In year 1, subgrantees 

recruited five pairs of sites (N=10) across blocks, per 

Westat guidance,7 and assigned one site within each 

pair to receive Shape NC TA and the other

site to be part of the year 1 comparison group 

(comparison sites received Shape NC TA in year 2). 

In year 2, subgrantees recruited additional sites, in a 

similar manner, per Westat guidance.8 This method of 

identifying blocks of similar sites increased the 

odds that treatment and comparison groups would 

be comparable each year. Sites flowed from the 

comparison to the treatment group between school 

years as illustrated in Exhibit B-1. It is important to 

note that Westat based its construction of blocks on 

available data and subgrantees’ deep knowledge of 

sites within their counties, and not on assessment 

data (e.g., needs or readiness assessments, or other 

tools identified through research).

Recruitment. To support subgrantee recruitment 

efforts, Westat created a brochure explaining the 

study and the benefits of participating for distribution 

to eligible sites. Directors of eligible sites who were 

interested in participating in the study returned 

a signed Memorandum of Understanding (MOU) 

indicating their agreement to participate. Westat 

also prepared information and consent forms for 

directors at participating sites to distribute to parents 

of children between 2 and 4 years old. Parent 

materials were available in English and Spanish. 

Parents returned signed consent forms indicating 

their permission for their child(ren) to be interviewed, 

weighed, and measured by Westat field staff. A tollfree number and study email address were included 

in the written materials provided to site staff and 

parents, who were encouraged to contact Westat 

with any questions or concerns, throughout the life of 

the study.

7 The number of sites in each block varies based on the size of the county and the number of children each site serves.

8 Due to state-mandated restrictions regarding face-to-face contact resulting from COVID-19, spring 2020 data collection was 

cancelled. Although subgrantees recruited new comparison sites prior to the 2019-20 school year, Westat was unable to collect the 

data necessary to include year 3 sites in this report.
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Shape NC Evaluation Report: Final Report

Exhibit B-1. Impact Study: Quasi-experimental delayed treatment design

NOTE: A total of 910 children received 1 year of treatment (Westat pooled data for the 586 children in Cohort 1/year 1 and the 

324 children in Cohort 2/year 2). A total of 210 children received 2 years of treatment (Cohort 1). The comparison group included 468 

children in Cohort 2/year 1 and 456 children in Cohort 3/year 2. Child attrition between years 1 and 2 was due to factors such as 

children no longer being enrolled at a site, for example.

Table B-1. Group Assignments, by year

A 20 Treatment Treatment

B 20 Comparison Treatment

C 20 Out of study Comparison

Impact A vs. B A and B vs. C

Group Number of sites 2017-18 2018-19
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Shape NC Evaluation Report: Final Report

Child-Level

In addition to calculating index scores at the site level, 

Westat calculated similar scores based on a set of key 

demographic variables used to adjust for differences 

among children in the treatment and comparison 

groups – in particular, age, gender, socioeconomic 

status (SES; subsidy eligibility information serves as a 

proxy for SES), and race/ethnicity.

Westat calculated child-level BMIs based on each 

child’s height and weight as follows: [weight 

(kilograms)/height (centimeters)]*10,000. However, it 

is important to note that a decreasing BMI percentile 

is not always a positive finding. For instance, a change 

from a BMI percentile in the healthy range to a 

percentile in the underweight range can be negative. 

Similarly, an increase in BMI percentile is not always 

a negative finding (e.g., moving from a percentile in 

the underweight range to a percentile in the healthy 

range can be positive). Therefore, the evaluation team 

examined changes in BMI percentiles in two ways. 

The team:

Preparation of Analytic Sample. Westat collected 

height and weight data from children in the fall and 

spring of years 1 and 2.9 10 The section below 

describes the approach used to prepare the analytic 

sample, steps used to clean data, followed by steps 

used to impute missing data. The evaluation team 

also provides the minimum detectable effect size 

(MDE) the study can estimate, given the size of the 

analytic samples.

Cleaning Steps

Year 1

To calculate each child’s Body Mass Index and 

 classify them into the correct weight category (i.e., 

underweight, healthy weight, overweight, obese), the 

evaluation team examined child-level demographic 

data (age and gender) and excluded cases with 

missing age or gender data, or that had an “out of 

scope” age (an age other than 2, 3, or 4 years old).

The evaluation team then identified cases with 

unusually large differences (growth of 7 or more 

centimeters in height or weight changes of 4 or more 

kilograms over six months) based on CDC guidelines 

for expected growth over a six-month time period 

for 2-, 3-, and 4-year-olds, by gender. The evaluation 

team made three types of adjustments:

• For cases where the height measurement was 

lower in spring 2018 than in fall 2017, calculate 

an average of the two measurements and use the 

result as a replacement for both data points.

• For cases where the height difference was 

greater than two standard deviations from CDC’s 

average growth rates based on age and gender, 

calculate an average of the two measurements 

and use the result as a replacement for both data 

collection points.

1. created a dichotomous variable based on BMI

percentile (1=healthy weight, 0=not healthy 

weight) for use as an outcome, since the goal of 

Shape NC TA is to support childcare sites in

increasing implementation of best practices to help 

all children achieve and maintain a healthy weight.

calculated changes in the BMI percentile within 

each of the four weight categories (i.e., obese, 

overweight, healthy weight, and underweight), 

based on recent research suggesting differential 

effects of obesity prevention interventions on weight 

(Lumeng et al., 2015; Wang et al., 2013).

2.

To estimate impact of Shape NC on children’s

BMI, food preferences, and activity habits, Westat 

calculated a score for each child and used it as a super 

covariate, and then used nested hierarchical linear 

modeling (HLM) to estimate child-level impacts.

9 In year 1, the evaluation team collected and analyzed children’s food and physical activity preference data. NCPC and Westat agreed 

that preference data are not reliable for younger children, so data were not collected from 2-year-old children in year 2 (height and 

weight data were collected from all children in years 1 and 2).

10The evaluation plan outlines a strategy to collect data from incoming 2-year-old children in cohort 1 sites in year 2. These children 

would be new to the program but the sites would be in the second year of implementation, so the experiences of these children 

would be different than the experiences of the other 2-year-old children. Therefore, new 2-year-old children were not recruited at 

cohort 1 sites in year 2.
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Shape NC Evaluation Report: Final Report

• For cases where the weight difference was greater 

or less than two standard deviations from CDC’s 

average weight gain based on age and gender, 

calculate an average of the two measurements and 

use the result as a replacement for both data points.

• Step 3: If missing data meet the MAR 

assumption, determine the imputation 

method. In this study, the classification and 

regression tree (CART) statistical model was used. 

CART utilizes the sequential regression model, 

in which all variables in the model are used as 

predictors to estimate the missing data for one 

variable. This method is a widely used Machine 

Learning Algorithm and performs well with both 

categorical and continuous data, such as the data 

collected for Shape NC TA, and is flexible to fit 

non-linear relationships. There are several studies 

showing the successful use of this method (van 

Buuren, 2018).

Following the steps above, the evaluation team 

retained 88 percent of data collected in year 1 and 97 

percent of data collected in year 2. Table B-2 shows 

the number of sites and children that received the 

treatment, and the MDE this study is likely to produce 

for different doses of the treatment. In calculation 

of the MDE, the evaluation team set the power 

parameter to .08, p < 0.05, intraclass correlation to 

0.10, and R2 to 0.50. (See Appendix C for the 

number of children in the treatment and comparison 

groups by key categories, before and after imputation 

for years 1 and 2.)

Year 2

In year 2, the evaluation team had to do a minimal 

data cleaning, mainly, it corrected measurement 

errors. For example, Westat corrected children’s 

weight when it was recorded in pounds instead of 

kilograms or adjusted height measurements11 that 

were recorded in fractions of a centimeter instead of 

full centimeters.

Imputation of missing data.

After making adjustments for measurement errors, 

Westat identified cases with missing data on child 

race, ethnicity, height, or weight. As specified in 

the evaluation plan, the evaluation team imputed 

missing data using a statistical model. The imputation 

approach was the same for year 1 and year 2 and 

consisted of the following steps to prevent the impact 

estimate from introducing biases:

• Step 1: Examine the patterns of missing data. 

The imputation is based on the predictive model 

and needs a set of predictors to estimate the values 

for the missing data. For this evaluation, they can 

be demographic data – i.e., demographic data are 

used to predict missing outcome data, or outcome 

data – i.e., outcome data are used to predict 

missing demographic data.

• Step 2: Identify potential cause of missing 

data. The level of missing data can be categorized 

as Missing Completely At Random (MCAR), Missing 

at Random (MAR), or Not Missing At Random 

(NMAR). Implementation of any imputation 

method is based on the assumption that there is

at least some missing data. This step is important 

in ensuring that the reason for missing data is not 

related to site- or child-level outcome measurement 

and covariates. If data are NMAR, estimates of 

treatment effects could be biased.

11 Due to children’s hairstyle, shoes, etc., the adjusted height was collected from some children.
36

Shape NC Evaluation Report: Final Report

Table B-2. Number of sites, children included in the analysis, and MDE, by number of years of treatment

NOTE: The study includes 924 children in 39 comparison sites.

Exhibit B-2 shows how cohorts of sites and children flowed through the evaluation across the 2 study years.12

Exhibit B-2. Number of children in each cohort receiving the treatment, by age

 

12 In year 1, the evaluation team collected and analyzed children’s food and physical activity preference data. NCPC and Westat agreed 

 that preference data are not reliable for younger children, so Westat did not collect data from 2-year-old children after spring 2018.

Number of years of treatment Number of 

sites

Number of 

children MDE

One year of treatment (Cohorts 1 and 2 combined) 40 910 0.2

Two years of treatment (Cohort 1 only) 20 210 0.4
37

Shape NC Evaluation Report: Final Report

Appendix C.

Imputation

Table C-1. Data collected in fall 2017 and spring 2018

Treatment Group (Cohort 1)

Comparison Group (Cohort 2)

Gender 467 1.49 0.50 468 1.50 0.50

Race 341 3.55 0.69 468 3.54 0.73

Ethnicity 354 1.81 0.39 468 1.81 0.39

Y1 Age 468 3.31 0.76 468 3.31 0.76

Y1 Subsidy 468 1.45 0.50 468 1.45 0.50

Fall 2017 weight 455 17.49 3.16 468 17.44 3.16

Fall 2017 Height 454 102.40 7.38 468 102.24 7.43

Spring 2018 weight 440 18.29 3.13 468 18.21 3.09

Spring 2018 height 440 105.66 7.29 468 105.53 7.23

Fall 2017 BMI 454 16.59 1.74 468 16.60 1.75

Spring 2018 BMI 440 15.31 1.52 468 16.27 1.51

Gender 585 1.51 0.50 586 1.52 0.50

Race 391 4.05 1.20 586 3.98 1.16

Ethnicity 395 1.83 0.37 586 1.85 0.36

Y1 Age 586 3.26 0.78 586 3.26 0.78

Y1 Subsidy 586 1.38 0.49 586 1.38 0.49

Fall 2017 weight 559 17.62 3.83 586 17.52 3.82

Fall 2017 Height 567 102.35 8.01 586 102.10 8.15

Spring 2018 weight 555 18.34 3.73 586 18.27 3.72

Spring 2018 height 555 105.56 7.94 586 105.42 7.96

Fall 2017 BMI 558 16.69 2.02 586 16.67 2.05

Spring 2018 BMI 555 16.34 1.77 586 16.31 1.79

Before Imputation After Imputation

n mean sd n mean sd
38

Shape NC Evaluation Report: Final Report

Table C-2. Data collected in fall 2018 and spring 2019

Treatment Group

Cohort 1

Cohort 2

Comparison Group (Cohort 3)

Gender 453 1.49 0.50 456 1.49 0.50 

Race 422 3.63 0.72 456 3.63 0.71 

Ethnicity 411 1.86 0.35 456 1.85 0.35 

Y2 Age 456 3.21 0.83 456 3.21 0.83 

Y2 Subsidy 456 1.45 0.50 456 1.45 0.50 

Spring 2018 weight 444 16.91 3.77 456 16.87 3.76 

Spring 2018 height 444 100.98 8.25 456 100.78 8.35 

Spring 2019 weight 419 18.09 4.14 456 18.07 4.14 

Spring 2019 height 419 104.71 7.97 456 104.67 8.06 

Spring 2018 BMI 444 16.45 1.97 456 16.47 1.96 

Spring 2019 BMI 416 16.34 1.95 456 13.33 1.93 

Gender 322 1.48 0.50 324 1.48 0.50 

Race 292 3.48 0.60 324 3.49 0.60 

Ethnicity 279 1.91 0.29 324 1.91 0.29 

Y2 Age 324 3.27 0.77 324 3.27 0.77 

Y2 Subsidy 324 1.45 0.50 324 1.45 0.50 

Spring 2018 weight 313 17.10 3.14 324 17.10 3.14 

Spring 2018 height 313 101.72 7.85 324 101.65 7.83 

Spring 2019 weight 294 18.35 3.54 324 18.38 3.53 

Spring 2019 height 294 105.51 7.89 324 105.49 7.84 

Spring 2018 BMI 313 16.43 1.55 324 16.45 1.54 

Spring 2019 BMI 294 16.37 1.67 324 16.41 1.75 

Gender 210 1.52 0.50 210 1.52 0.50 

Race 210 3.52 0.69 210 3.52 0.69 

Ethnicity 210 1.91 0.29 210 1.91 0.29 

Y2 Age 210 3.63 0.48 210 3.63 0.48 

Y2 Subsidy 210 1.32 0.47 210 1.32 0.47 

Fall 2017 weight 210 15.76 2.73 210 15.76 2.73 

Fall 2017 Height 210 96.95 6.62 210 96.95 6.62 

Spring 2018 weight 210 16.53 2.74 210 16.53 2.74 

Spring 2018 height 210 100.44 6.42 210 100.44 6.42 

Spring 2019 weight 199 19.15 3.66 210 19.22 3.73 

Spring 2019 height 199 108.05 6.36 210 108.09 6.66 

Spring 2019 BMI 199 16.29 1.94 210 16.33 1.92 

Before Imputation After Imputation

n mean sd n mean sd
39

Shape NC Evaluation Report: Final Report

Appendix D.

Supplemental Baseline Equivalence Data

Baseline Equivalence

Year 1 Treatment vs Year 1 Comparison

Table D-1. Percentage of sites with key characteristics at baseline

SOURCE: North Carolina Department of Health and Human Services, Division of Child Development and Early Education, Fall 2017. 

Table D-2. Food and physical activity policies

Written policy in the parent handbook about:

SOURCE: Director survey, Fall 2017. 

Foods brought from home for 

meals and snacks 75.0 0.44 60.0 0.50 15.0 0.16 0.32

Food brought from home for 

onsite celebrations that include 

children 70.0 0.47 60.0 0.50 10.0 0.10 0.51

Food and

beverages staff consume in front 

of children 10.0 0.31 20.0 0.41 10.0 0.18 0.38

Use of food as a reward for 

children's behavior 35.0 0.49 30.0 0.47 5.0 0.05 0.74

Physical education and/or 

physical activity 60.0 0.50 45.0 0.51 15.0 0.14 0.34

Practice/policy on food 

and physical activity

Year 1 

Treatment 

(n=20)

Year 1 

Comparison 

(n=20)

Absolute 

difference 

between groups

Percent SD Percent SD Percent ES p-value

Nutrition practices exceed USDA's 

CACFP nutrition standards 40.0% 0.50 40.0% 0.50 0.0% 0.00 1.00

Characteristic

Year 1 

Treatment 

(n=20)

Year 1 

Comparison 

(n=20)

Total 

(n=40)

Children eligible for subsidies 95.0% 90.0% 92.5%

Quality star rating of 5 85.0 80.0 82.5

Program standards points of 5 or higher 80.0 80.0 80.0

Category of operation as independent 75.0 75.0 75.0

7 Lead teacher education points 60.0 70.0 65.0

In operation for 2 or more years 40.0 50.0 45.0

Enrollment capacity of 90 or more children 45.0 40.0 42.5

Average weighted index score 2.39 2.38 2.38
40

Shape NC Evaluation Report: Final Report

Table D-3. Child-level outcomes

SOURCES: Child interview and child height and weight measurement, Fall 2017. 

Baseline Equivalence

Year 2 Treatment vs Year 2 Comparison

Table D-4. Percentage of sites with key characteristics at baseline

SOURCE: North Carolina Department of Health and Human Services, Division of Child Development and Early Education, Fall 2018. 

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the 

subgrantee, even though it did not meet the program quality rating requirement. 

Characteristic

Year 2 

Treatment 

(n=20)

Year 2 

Comparison 

(n=19)

Total 

(n=39)

Children eligible for subsidies 85.0 94.7 89.7

Quality star rating of 5 80.0 52.6 66.7

Program standards points of 5 or higher 90.0 73.7 82.1

Category of operation as independent 75.0 84.2 79.5

7 Lead teacher education points 75.0 63.2 69.2

In operation for 2 or more years 50.0 21.1 35.9

Enrollment capacity of 90 or more children 45.0 47.4 46.2

Average weighted index score 2.38 2.19 2.29

Outcomes

Year 1 

Treatment 

(n=523)

Year 1 

Comparison 

(n=416)

Absolute 

difference 

between groups

Mean SD Mean SD Mean ES p-value

Body Mass Index (BMI) 16.70 2.04 16.60 2.04 0.10 0.01 0.60

2-year-olds 16.81 1.69 16.97 1.45 0.15 0.04 0.56

3-year-olds 16.61 1.80 16.52 1.77 0.09 0.02 0.66

4-year-olds 16.72 2.31 16.60 1.78 0.12 0.02 0.53

Food and activity preferences 13.30 2.24 13.30 2.26 0.00 0.00 0.99

2-year-olds 13.54 2.41 13.70 2.35 0.16 0.03 0.15

3-year-olds 13.54 2.21 13.48 2.12 0.06 0.01 0.85

4-year-olds 13.07 2.19 13.02 2.30 0.05 0.01 0.82
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Shape NC Evaluation Report: Final Report

Table D-5. Food and physical activity policies

Written policy in the parent handbook about:

SOURCE: Director survey, Fall 2018. 

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the 

subgrantee, even though it did not meet the program quality rating requirement. 

Table D-6. Child-level outcomes

SOURCES: Child interview and child height and weight measurement, fall 2018. 

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the 

subgrantee, even though it did not meet the program quality rating requirement. 

Outcomes

Year 2 

Treatment 

(n=255)

Year 2 

Comparison 

(n=374)

Absolute 

difference 

between groups

Mean SD Mean SD Mean ES p-value

BMI 16.41 1.45 16.40 1.83 0.01 0.00 0.96

2-year-olds 16.88 1.54 16.79 1.42 0.10 0.03 0.69

3-year-olds 16.36 1.31 16.22 1.95 0.14 0.03 0.60

4-year-olds 16.23 1.46 16.28 1.94 0.04 0.01 0.84

Food and activity preferences 13.57 1.92 13.24 2.20 0.33 0.06 0.09

3-year-olds 13.93 1.70 13.66 2.33 0.27 0.05 0.40

4-year-olds 13.36 2.01 13.03 2.11 0.33 0.06 0.17

Foods brought from home for 

meals and snacks 83.3 0.38 57.9 0.51 25.4 0.27 0.09

Food brought from home for 

onsite celebrations that include 

children 63.2 0.50 52.6 0.51 10.5 0.10 0.52

Food and

beverages staff consume in front 

of children 31.6 0.48 10.5 0.32 21.1 0.29 0.12

Use of food as a reward for 

children's behavior 40.0 0.50 15.8 0.37 24.2 0.27 0.10

Physical education and/or 

physical activity 50.0 0.51 42.1 0.51 7.9 0.08 0.63

Practice/policy on food and 

physical activity

Year 2 

Treatment 

(n=20)

Year 2 

Comparison 

(n=19)

Absolute 

difference 

between groups

Percent SD Percent SD Percent ES p-value

Nutrition practices exceed USDA's 

CACFP nutrition standards 31.6% 0.48 42.1% 0.51 10.5% 0.10 0.51
Shape NC Evaluation Report: Final Report 42

Table D-7. Number and percentage of sites with previous health-related program experience (at baseline)

SOURCES: Director interview (year 1 treatment sites and year 2 treatment sites), fall 2017, and site intake form (year 2 comparison sites), fall 2018. 

NOTE: Data from one year 2 comparison site that did not meet the program quality rating requirement but was included at the request of the subgrantee are excluded from the 

analysis. 

Previous Health-Related Program Experience

Year 1 

Treatment Sites 

(n = 20)

Year 2 

Treatment Sites 

(n = 20)

Year 2 

Comparison Sites 

(n = 19)

Number Percent Number Percent Number Percent

Experience participating in physical activity or nutrition programs

Prior participation 7 35.0% 10 50.0% 13 68.4%

No prior participation 11 55.0 9 45.0 6 31.6

Don’t know 2 10.0 1 5.0 0 0.0

Shape NC programs previously implemented

NAP SACC or GO NAP SACC 2 10.0 2 10.0 1 5.3

Be Active Kids® (BAK®) 1 5.0 1 5.0 6 31.6

Preventing Obesity by Design (POD or NLI) 0 0.0 1 5.0 6 31.6

Other similar programs previously implemented

Childcare Health Consultant Program (CCHC) 2 10.0 3 15.0 6 31.6

Kindermusik 1 5.0 1 5.0 0 0.0

Imagination Yoga 1 5.0 1 5.0 0 0.0

Wellness Works Wonders 0 0.0 1 5.0 0 0.0

Color Me Healthy 0 0.0 2 10.0 0 0.0

Fresh Fruit & Vegetable Grant 0 0.0 0 0.0 1 5.3

Healthy Me, Healthy We 0 0.0 0 0.0 1 5.3
Shape NC Evaluation Report: Final Report 43

Table D-8. Number and percentage of sites with nutrition practices aligned with USDA’s Child and Adult Care Food 

Program (CACFP) standards

SOURCES: Director survey, fall 2017 and fall 2018. 

NOTE: Data from one year 2 comparison site that did not meet the program quality rating requirement but was included at the request of the subgrantee are excluded from the 

analysis. 

Do site nutrition practices exceed USDA’s CACFP standards?

Year 1 

Treatment Sites 

(n = 20)

Year 2 

Treatment Sites 

(n = 20)

Year 2 

Comparison Sites 

(n = 19)

Number Percent Number Percent Number Percent

Yes, site practices exceed CACFP nutrition standards 12 60.0% 6 30.0% 9 47.4%

No, but site practices align with CACFP standards 6 30.0 12 60.0 9 47.4

No, site practices do not meet CACFP standards 1 5.0 1 5.0 0 0.0

Not familiar with CACFP standards 1 5.0 1 5.0 1 5.3
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Appendix E.

HLM Tables

Table E-1. Examining Healthy weight categories>

Model specification Estimate Std. error z-value P-value

Model 1: With propensity score

Group assignment (Treatment) -0.71 0.23 -3.14 0.00

Child propensity 1.89 1.37 1.38 0.17

Time 1 0.55 0.15 3.79 0.00

Time 2 -0.82 0.31 -2.66 0.00

Model 2: With child demographic

Group assignment (Treatment) -0.48 0.24 -2.02 0.04

Gender (Girl) -0.71 0.18 -3.86 0.00

Age -0.19 0.31 -0.62 0.53

Race 1 (Black) -0.32 0.55 -0.59 0.56

Race 2 (White) -0.06 0.54 -0.11 0.91

Ethnicity (Hispanic) 0.52 0.45 1.15 0.25

Subsidy (Received) -0.35 0.31 -1.12 0.26

Time 1 0.54 0.14 3.75 0.00

Time 2 -0.24 0.34 -0.71 0.47
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Table E-2. Examining BMI percentile>

Model specification Estimate Std. error t-value P-value

Model 1: With propensity score 

Group assignment (treatment) 0.04 0.06 0.64 0.52 

Site level covariates 

Children eligible for subsidies 0.09 0.22 0.43 0.67 

Category of operation as independent -0.03 0.14 -0.24 0.81 

Quality star rating of 5 0.20 0.21 0.97 0.34 

7 Lead teacher education points -0.04 0.13 -0.28 0.78 

Program standards points of 5 or higher -0.06 0.23 -0.25 0.78 

Enrollment capacity of 90 or more 

children -0.02 0.12 -0.15 0.88 

In operation for 2 or more years -0.22 0.11 -1.94 0.06 

Child level covariate 

Propensity score 0.73 0.38 1.93 0.05 

Time 1 -0.24 0.02 -11.05 0.00 

Time 2 -0.29 0.06 -5.11 0.00 

Model 2: With child demographic 

Group assignment (treatment) -0.00 0.06 -0.00 1.00 

Site level covariates 

Children eligible for subsidies 0.07 0.22 0.34 0.74 

Category of operation as independent -0.13 0.14 -0.95 0.35 

Quality star rating of 5 0.26 0.21 1.25 0.21 

7 Lead teacher education points -0.11 0.13 -0.80 0.43 

Program standards points of 5 or higher -0.06 0.22 -0.27 0.78 

Enrollment capacity of 90 or more 

children 0.01 0.11 0.11 0.91 

In operation for 2 or more years -0.18 0.11 -1.60 0.11 

Child level covariate 

Age -0.06 0.05 -1.12 0.26 

Gender (Girl) -0.04 0.09 -0.49 0.62 

Race 1 (Black) 0.28 0.16 1.82 0.07 

Race 2 (White) 0.16 0.15 1.11 0.27 

Ethnicity (Hispanic) -0.14 0.12 -1.15 0.25 

Subsidy (Received) 0.05 0.08 0.67 0.50 

Time 1 -0.24 0.02 -11.02 0.00 

Time 2 -0.23 0.07 -3.15 0.00 
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Appendix F.

Outcome Data Disaggregated by County
Shape NC Evaluation Report: Final Report

Durham County

47

Site Level Results - Nutrition

Table F-1. Food and physical activity policies

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director survey, fall 2017, fall 2018, and spring 2019; Director interview, spring 2018. 

Policy on food and physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Foods brought from home for meals and snacks

No policy 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

Informal policy 1 20.0 2 40.0 2 20.0 3 30.0 2 20.0 3 30.0

Written policy 3 60.0 3 60.0 7 70.0 6 60.0 7 70.0 7 70.0

Food brought from home for onsite celebrations that include 

children

No policy 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 0 0.0

Informal policy 2 40.0 2 40.0 3 30.0 3 30.0 2 20.0 3 30.0

Written policy 3 60.0 3 60.0 7 70.0 5 50.0 7 70.0 7 70.0

Food and beverages staff consume in front of children

No policy 1 20.0 0 0.0 1 10.0 0 0.0 2 20.0 1 10.0

Informal policy 1 20.0 1 20.0 2 20.0 3 30.0 4 40.0 3 30.0

Written policy 3 60.0 4 80.0 7 70.0 6 60.0 3 30.0 6 60.0

Use of food as a reward for children's behavior

No policy 2 40.0 1 20.0 4 40.0 5 50.0 3 30.0 3 30.0

Informal policy 2 40.0 0 0.0 4 40.0 1 10.0 4 40.0 3 30.0

Written policy 1 20.0 4 80.0 2 20.0 3 30.0 2 20.0 4 40.0

Physical education and/or physical activity

No policy 2 40.0 1 20.0 4 40.0 2 20.0 1 10.0 1 10.0

Informal policy 0 0.0 0 0.0 1 10.0 3 30.0 2 20.0 2 20.0

Written policy 3 60.0 4 80.0 5 50.0 330.0 6 60.0 7 70.0

Children’s use of computers

No policy 0 0.0 1 20.0 1 10.0 3 30.0 3 30.0 2 20.0

Informal policy 3 60.0 1 20.0 5 50.0 2 20.0 2 20.0 2 20.0

Written policy 2 40.0 3 60.0 4 40.0 4 40.0 4 40.0 6 60.0
Shape NC Evaluation Report: Final Report 48

Table F-2. Challenges reported by sites to promote healthy eating

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019. 

Challenges to healthy eating

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 1 20.0% 1 20.0% 4 40.0% 2 20.0% 6 60.0% 5 50.0%

Lack of nutrition education 

resources 2 40.0 0 0.0 5 50.0 3 30.0 6 60.0 5 50.0

Limited time to teach 

nutrition 1 20.0 1 20.0 5 50.0 5 50.0 7 70.0 6 60.0

Lack of access to fresh fruits 

and vegetables 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 0 0.0

Lack of funding to purchase 

healthy foods 1 20.0 1 20.0 4 40.0 5 50.0 1 10.0 3 30.0
Shape NC Evaluation Report: Final Report 49

Site Level Results – Physical Activity

Table F-3. Key features of the site’s physical education/physical activity policy

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019. 

Physical activity policy

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

No policy for physical activity 1 20.0% 1 20.0% 3 30.0% 2 20.0% 1 10.0% 1 10.0%

At least one hour of outdoor 

play daily 3 60.0 2 40.0 3 30.0 6 60.0 6 60.0 6 70.0

Less than one hour of outdoor 

play daily 0 0.0 2 40.0 3 30.0 2 20.0 2 20.0 2 20.0

Outdoor play daily (amount of 

time unspecified) 1 20.0 0 0.0 1 10.0 0 0.0 1 10.0 1 0.0
Shape NC Evaluation Report: Final Report

Table F-4. Type 

50

of indoor and outdoor physical activity

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019. 

Types of physical activities | 

children are involved in

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Indoor activity

Free play 0 0.0% 5 100.0% 5 50.0% 7 70.0% 5 50.0% 7 70.0%

Structured play/organized games 2 40.0 5 100.0 5 50.0 7 70.0 5 50.0 6 60.0

Sports 1 20.0 0 0.0 2 20.0 0 0.0 2 20.0 2 20.0

Cardiovascular exercise 5 100.0 5 100.0 10 100.0 8 80.0 9 90.0 9 90.0

Balancing 2 40.0 3 60.0 6 60.0 4 40.0 7 70.0 4 40.0

Stretching 1 20.0 5 100.0 5 50.0 6 60.0 4 40.0 5 50.0

Outdoor activity

Free play 5 100.0 5 100.0 10 100.0 5 50.0 10 100.0 5 50.0

Structured play/organized games 0 0.0 3 60.0 3 30.0 7 70.0 3 30.0 5 50.0

Sports 2 40.0 3 60.0 6 60.0 6 60.0 7 70.0 7 70.0

Cardiovascular exercise 1 20.0 5 100.0 6 60.0 7 70.0 8 80.0 7 70.0

Climbing/sliding/swinging 3 60.0 5 100.0 7 70.0 8 80.0 8 80.0 7 70.0

Playing/building with loose toys 4 80.0 5 100.0 9 90.0 5 50.0 9 90.0 6 60.0

Riding bikes/riding toys 5 100.0 5 100.0 9 90.0 8 80.0 7 70.0 6 60.0

Balancing 3 60.0 4 80.0 6 60.0 5 50.0 5 50.0 6 60.0
Shape NC Evaluation Report: Final Report

Table F-5. Challenges reported by sites to promote physical activity

51

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019. 

Challenges to physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 3 60.0% 1 20.0% 70.0% 3 30.0% 6 60.0% 6 60.0%

Lack of appropriate physical 

education resources 1 20.0 1 20.0 4 40.0 4 40.0 3 30.0 7 70.0

Lack of funding to purchase 

equipment 1 20.0 1 20.0 4 40.0 4 40.0 3 30.0 4 40.0
Shape NC Evaluation Report: Final Report

Child Level Results

52

Table F-6. Average child BMI

NOTE: Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 

treatment sites that received treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

Table F-7. Percent of children in BMI weight category

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

BMI category

Treatment 

2 years

(n = 46)

Treatment 

1 year

(n = 144)

Comparison 

(n= 199)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Healthy weight 71.7% 50.0% 70.8% 73.6% 72.4% 77.9% 

Overweight 19.6 19.6 16.7 12.5 13.6 10.6 

Obese 8.7 21.7 9.7 7.6 7.5 6.0 

Underweight 0.0 8.7 2.8 6.3 6.5 5.5 

BMI category

Treatment 

2 years

(n = 46)

Treatment 

1 year

(n = 144)

Comparison 

(n = 199)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Overall 16.88 16.59 16.57 16.31 16.43 16.28 

Healthy weight 16.05 15.71 15.94 15.69 16.03 15.86 

Overweight 18.26 18.10 17.85 17.66 17.75 17.45 

Obese 20.53 20.53 19.92 19.27 20.48 19.65 

Underweight n/a n/a 13.44 13.62 13.41 14.56 
Shape NC Evaluation Report: Final Report

Randolph County

53

Site Level Results - Nutrition

Table F-8. Food and physical activity policies

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director survey, fall 2017, fall 2018, and spring 2019; Director interview, spring 2018. 

Policy on food and physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 9)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Foods brought from home for meals and snacks

No policy 1 20.0% 0 0.0 1 10.0% 0 0.0% 2 22.2% 0 0.0%

Informal policy 0 0.0 0 0.0 0 0.0 0 0.0 1 11.1 0 0.0

Written policy 4 80.0 5 100.0 8 80.0 10 100.0 6 66.7 9 100.0

Food brought from home for onsite celebrations that include 

children

No policy 0 0.0 1 20.0 1 10.0 1 10.0 2 22.2 3 33.3

Informal policy 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 0 0.0

Written policy 5 100.0 4 80.0 8 80.0 8 80.0 7 77.8 6 66.7

Food and beverages staff consume in front of children

No policy 0 0.0 0 0.0 0 0.0 0 0.0 2 22.2 0 0.0

Informal policy 2 40.0 1 20.0 2 20.0 5 50.0 2 22.2 2 22.2

Written policy 2 40.0 4 80.0 6 60.0 4 40.0 5 55.6 7 77.8

Use of food as a reward for children's behavior

No policy 0 0.0 0 0.0 1 10.0 1 10.0 4 44.4 5 55.6

Informal policy 2 40.0 1 20.0 3 30.0 3 30.0 2 22.2 2 22.2

Written policy 3 60.0 4 80.0 6 60.0 6 60.0 3 33.3 2 22.2

Physical education and/or physical activity

No policy 0 0.0 0 0.0 0 0.0 0 0.0 1 11.1 0 0.0

Informal policy 1 20.0 0 0.0 1 10.0 2 20.0 0 0.0 1 11.1

Written policy 4 80.0 5 100.0 9 90.0 8 80.0 8 88.9 8 88.9

Children’s use of computers

No policy 0 0.0 1 20.0 1 10.0 1 10.0 1 11.1 1 11.1

Informal policy 3 60.0 1 20.0 4 40.0 4 40.0 2 22.2 3 33.3

Written policy 2 40.0 3 60.0 5 50.0 5 50.0 6 66.7 5 55.6
Shape NC Evaluation Report: Final Report

Table F-9. Challenges reported by sites to promote healthy eating

54

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Challenges to healthy eating

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 9)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 2 40.0% 0 0.0% 2 20.0% 1 10.0% 0 0.0% 2 22.2%

Lack of nutrition education 

resources 1 20.0 0 0.0 1 10.0 0 0.0 2 22.2 1 11.1

Limited time to teach 

nutrition 1 20.0 0 0.0 2 20.0 4 40.0 2 22.2 1 11.1

Lack of access to fresh fruits 

and vegetables 0 0.0 1 20.0 2 20.0 3 30.0 0 0.0 2 22.2

Lack of funding to purchase 

healthy foods 0 0.0 1 20.0 0 0.0 5 50.0 2 22.2 1 11.1
Shape NC Evaluation Report: Final Report 55

Site Level Results – Physical Activity

Table F-10. Key features of the site’s physical education/physical activity policy

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and Year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Physical activity policy

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 9)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

No policy for physical activity 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 11.1% 0 0.0%

At least one hour of outdoor 

play daily 5 100.0 3 60.0 6 60.0 6 60.0 7 77.8 6 66.7

Less than one hour of outdoor 

play daily 0 0.0 2 40.0 4 40.0 4 40.0 1 11.1 3 33.3

Outdoor play daily (amount of 

time unspecified) 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Shape NC Evaluation Report: Final Report

Table F-11. Type of indoor and outdoor physical activity

56

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Types of physical activities | 

children are involved in

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 9)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Indoor activity

Free play 0 0.0% 5 100.0% 5 50.0% 5 50.0% 6 66.7% 6 66.7%

Structured play/organized games 1 20.0 4 80.0 5 50.0 5 50.0 4 44.4 7 77.8

Sports 0 0.0 1 20.0 0 0.0 0 0.0 0 0.0 0 0.0

Cardiovascular exercise 5 100.0 3 60.0 10 100.0 10 100.0 9 100.0 7 77.8

Balancing 0 0.0 2 40.0 3 30.0 5 50.0 3 33.3 1 11.1

Stretching 1 20.0 3 60.0 5 50.0 4 40.0 5 55.6 5 55.6

Outdoor activity

Free play 5 100.0 5 100.0 9 90.0 9 90.0 9 100.0 6 66.7

Structured play/organized games 0 0.0 5 100.0 4 40.0 7 70.0 5 55.6 6 66.7

Sports 1 20.0 2 40.0 3 30.0 4 40.0 6 66.7 3 33.3

Cardiovascular exercise 4 80.0 5 100.0 8 80.0 8 80.0 7 77.8 7 77.8

Climbing/sliding/swinging 4 80.0 5 100.0 7 70.0 5 50.0 9 100.0 7 77.8

Playing/building with loose toys 4 80.0 5 100.0 8 80.0 7 70.0 7 77.8 8 88.9

Riding bikes/riding toys 4 80.0 5 100.0 8 80.0 5 50.0 6 66.7 5 55.6

Balancing 1 20.0 3 60.0 5 50.0 5 50.0 3 33.3 3 33.3
Shape NC Evaluation Report: Final Report

Table F-12. Challenges reported by sites to promote physical activity

57

SOURCES: Director interview, fall 2017and spring 2018; Director survey, fall 2018 and spring 2019. 

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

Challenges to physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 9)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 1 20.0% 0 0.0% 1 10.0% 1 10.0% 0 0.0% 2 22.2%

Lack of appropriate physical 

education resources 1 20.0 0 0.0 2 20.0 0 0.0 5 55.6 1 11.1

Lack of funding to purchase 

equipment 1 20.0 0 0.0 2 20.0 2 20.0 1 11.1 2 22.2
Shape NC Evaluation Report: Final Report 58

Child Level Results

Table F-13. Average child BMI

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment 

includes cohort 1 treatment sites that received treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

Table F-14. Percent of children in BMI weight category

NOTE: Data from one year 2 comparison site are excluded from the analysis. This site was included at the request of the subgrantee, even though it did not meet the program 

quality rating requirement. Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). 

Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment 

sites that received treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

BMI category

Treatment 

2 years

(n = 38)

Treatment 

1 year

(n = 169)

Comparison 

(n = 197)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Healthy weight 71.1% 73.7% 63.9% 69.2% 71.1% 77.7% 

Overweight 15.8 13.2 17.8 19.5 18.3 11.7 

Obese 7.9 10.5 16.6 9.5 10.2 9.1 

Underweight 5.3 2.6 1.8 1.8 0.5 1.5 

BMI category

Treatment 

2 years

(n = 38)

Treatment 

1 year

(n =169)

Comparison 

(n = 197)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Overall 16.52 16.20 16.69 16.41 16.63 16.34 

Healthy weight 16.13 15.83 15.74 15.62 15.89 15.73 

Overweight 18.09 17.77 17.72 17.44 17.60 17.10 

Obese 18.44 17.83 19.57 18.59 20.14 19.24 

Underweight 14.18 14.05 13.95 14.27 14.60 14.83 
Shape NC Evaluation Report: Final Report 59

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director survey, fall 2017, fall 2018, and spring 2019; Director interview, spring 2018. 

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Foods brought from home for meals and snacks

No policy 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

Informal policy 0 0.0 0 0.0 1 10.0 2 20.0 3 30.0 3 30.0

Written policy 5 100.0 5 100.0 8 80.0 8 80.0 7 70.0 7 70.0

Food brought from home for onsite celebrations that include 

children

No policy 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 0 0.0

Informal policy 0 0.0 1 20.0 3 30.0 2 20.0 3 30.0 2 20.0

Written policy 4 80.0 4 80.0 6 60.0 6 60.0 7 70.0 8 80.0

Food and beverages staff consume in front of children

No policy 0 0.0 0 0.0 1 10.0 0 0.0 1 10.0 1 10.0

Informal policy 2 40.0 1 20.0 4 40.0 4 40.0 3 30.0 3 30.0

Written policy 3 60.0 4 80.0 5 50.0 6 60.0 5 50.0 5 50.0

Use of food as a reward for children's behavior

No policy 0 0.0 1 20.0 1 10.0 2 20.0 2 20.0 3 30.0

Informal policy 1 20.0 0 0.0 3 30.0 2 20.0 2 20.0 1 10.0

Written policy 4 80.0 4 80.0 6 60.0 6 60.0 5 50.0 5 50.0

Physical education and/or physical activity

No policy 0 0.0 1 20.0 0 0.0 1 10.0 0 0.0 0 0.0

Informal policy 1 20.0 0 0.0 3 30.0 3 30.0 3 30.0 3 30.0

Written policy 4 80.0 4 80.0 7 70.0 6 60.0 7 70.0 7 70.0

Children’s use of computers

No policy 0 0.0 0 0.0 0 0.0 2 20.0 1 10.0 1 10.0

Informal policy 1 20.0 1 20.0 3 30.0 2 20.0 4 40.0 5 50.0

Written policy 4 80.0 3 60.0 7 70.0 6 60.0 5 50.0 4 40.0

Wake County

Site Level Results - Nutrition

Table F-15. Food and physical activity policies
Shape NC Evaluation Report: Final Report

Table F-16.

60

Challenges reported by sites to promote healthy eating

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018and spring 2019. 

Challenges to healthy eating

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 1 20.0% 1 20.0% 4 40.0% 3 30.0% 3 30.0% 5 50.0%

Lack of nutrition education 

resources 0 0.0 2 40.0 2 20.0 4 40.0 2 20.0 4 40.0

Limited time to teach 

nutrition 1 20.0 0 0.0 4 40.0 2 20.0 2 20.0 4 40.0

Lack of access to fresh fruits 

and vegetables 1 20.0 0 0.0 1 10.0 3 30.0 2 20.0 3 30.0

Lack of funding to purchase 

healthy foods 1 20.0 1 20.0 1 10.0 3 30.0 5 50.0 5 50.0
Shape NC Evaluation Report: Final Report

Site Level Results – Physical Activity

61

Table F-17. Key features of the site’s physical education/physical activity policy

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Physical activity policy

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

No policy for physical activity 0 0.0% 1 20.0% 0 0.0% 1 10.0% 0 0.0% 0 0.0%

At least one hour of outdoor 

play daily 4 80.0 3 60.0 7 70.0 6 60.0 5 50.0 6 60.0

Less than one hour of outdoor 

play daily 1 20.0 1 20.0 3 30.0 3 30.0 4 40.0 3 30.0

Outdoor play daily (amount of 

time unspecified) 0 0.0 0 0.0 0 0.0 0 0.0 1 10.0 1 10.0
Shape NC Evaluation Report: Final Report 62

Table F-18. Type of indoor and outdoor physical activity

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Types of physical activities | 

children are involved in

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Indoor activity

Free play 1 20.0% 5 100.0% 6 60.0% 7 70.0% 5 50.0% 7 70.0%

Structured play/organized games 2 40.0 5 100.0 6 60.0 6 60.0 8 80.0 7 70.0

Sports 1 20.0 0 0.0 2 20.0 1 10.0 2 20.0 2 20.0

Cardiovascular exercise 5 100.0 5 100.0 9 90.0 7 70.0 10 100.0 9 90.0

Balancing 0 0.0 4 80.0 2 40.0 2 40.0 6 60.0 4 40.0

Stretching 0 0.0 5 100.0 3 30.0 4 40.0 6 60.0 6 60.0

Outdoor activity

Free play 5 100.0 5 100.0 8 80.0 7 70.0 9 90.0 5 50.0

Structured play/organized games 10 20. 4 80.0 3 30.0 7 70.0 5 50.0 5 50.0

Sports 2 40.0 3 60.0 5 50.0 6 60.0 6 60.0 6 60.0

Cardiovascular exercise 1 20.0 5 100.0 4 40.0 8 80.0 9 90.0 8 80.0

Climbing/sliding/swinging 2 40.0 4 80.0 5 50.0 7 70.0 7 70.0 5 50.0

Playing/building with loose toys 3 60.0 5 100.0 6 60.0 5 50.0 8 80.0 6 60.0

Riding bikes/riding toys 4 80.0 5 100.0 6 60.0 8 80.0 8 80.0 6 60.0

Balancing 1 20.0 5 100.0 4 40.0 5 50.0 4 40.0 4 40.0
Shape NC Evaluation Report: Final Report

Table F-19.

63

Challenges reported by sites to promote physical activity

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Challenges to physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 2 40.0% 2 40.0% 6 60.0% 3 30.0% 5 50.0% 4 40.0%

Lack of appropriate physical 

education resources 0 0.0 1 20.0 2 20.0 3 30.0 2 20.0 7 70.0

Lack of funding to purchase 

equipment 2 40.0 0 0.0 3 30.0 5 50.0 3 30.0 5 50.0
Shape NC Evaluation Report: Final Report

Child Level Results

64

Table F-20. Average child BMI

NOTE: Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 

treatment sites that received treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

Table F-21. Percent of children in BMI weight category

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in Year 1 (cohort 2) and Year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in Years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (Year 1 and Year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

BMI category

Treatment 

2 years

(n = 15)

Treatment 

1 year

(n = 150)

Comparison 

(n = 205)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Healthy weight 93.3% 80.0% 72.7% 73.3% 71.1% 73.2% 

Overweight 6.7 13.3 12.0 11.3 12.2 11.7 

Obese 0.0 6.7 10.7 10.7 11.7 9.3 

Underweight 0.0 0.0 4.7 4.7 4.4 5.9 

BMI category

Treatment 

2 years

(n = 15)

Treatment 

1 year

(n = 150)

Comparison 

(n = 205)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Overall 16.66 16.21 16.44 16.27 16.34 16.17 

Healthy weight 16.47 16.13 15.95 15.80 15.78 15.65 

Overweight 19.31 17.32 17.75 17.50 17.83 17.24 

Obese n/a n/a 19.58 19.12 19.25 18.99 

Underweight n/a n/a 13.43 13.88 13.50 14.18 
Shape NC Evaluation Report: Final Report

Wilson County

65

Site Level Results - Nutrition

Table F-22. Food and physical activity policies

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in Years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director survey, fall 2017, fall 2018, and spring 2019; Director interview, spring 2018. 

Policy on food and physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Foods brought from home for meals and snacks

No policy 0 0.0% 0 0.0% 0 0.0% 1 10.0% 2 20.0% 1 10.0%

Informal policy 1 20.0 2 40.0 2 20.0 2 20.0 3 30.0 5 50.0

Written policy 4 80.0 3 60.0 8 80.0 7 70.0 5 50.0 4 40.0

Food brought from home for onsite celebrations that include 

children

No policy 1 20.0 1 20.0 2 20.0 3 30.0 1 10.0 0 0.0

Informal policy 1 20.0 1 20.0 2 20.0 1 10.0 5 50.0 7 70.0

Written policy 3 60.0 3 60.0 6 60.0 6 60.0 4 40.0 3 30.0

Food and beverages staff consume in front of children

No policy 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Informal policy 3 60.0 3 60.0 5 50.0 6 60.0 6 60.0 6 60.0

Written policy 2 40.0 2 40.0 5 50.0 4 40.0 4 40.0 4 40.0

Use of food as a reward for children's behavior

No policy 2 40.0 2 40.0 3 30.0 4 40.0 7 70.0 7 70.0

Informal policy 2 40.0 1 20.0 4 40.0 3 30.0 3 30.0 3 30.0

Written policy 1 20.0 2 40.0 3 30.0 3 30.0 0 0.0 0 0.0

Physical education and/or physical activity

No policy 1 20.0 1 20.0 3 30.0 4 40.0 4 40.0 4 40.0

Informal policy 0 0.0 2 40.0 1 10.0 1 10.0 2 20.0 4 40.0

Written policy 3 60.0 2 40.0 5 50.0 5 50.0 4 40.0 2 20.0

Children’s use of computers

No policy 1 20.0 0 0.0 2 20.0 1 10.0 2 20.0 2 20.0

Informal policy 3 60.0 3 60.0 5 50.0 6 60.0 4 40.0 5 50.0

Written policy 1 20.0 2 40.0 3 30.0 3 30.0 4 40.0 3 30.0
Shape NC Evaluation Report: Final Report

Table F-23. Challenges reported by sites to promote healthy eating

66

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018, and spring 2019. 

Challenges to healthy eating

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 3 60.0% 2 40.0% 7 70.0% 5 50.0% 6 60.0% 6 60.0%

Lack of nutrition education 

resources 1 20.0 0 0.0 4 40.0 4 40.0 4 40.0 5 50.0

Limited time to teach 

nutrition 2 40.0 0 0.0 5 50.0 4 40.0 3 30.0 3 30.0

Lack of access to fresh fruits 

and vegetables 0 0.0 1 20.0 0 0.0 5 50.0 3 30.0 3 30.0

Lack of funding to purchase 

healthy foods 2 40.0 3 60.0 5 50.0 6 60.0 3 30.0 5 50.0
Shape NC Evaluation Report: Final Report 67

Site Level Results – Physical Activity

Table F-24. Key features of the site’s physical education/physical activity policy

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Physical activity policy

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

No policy for physical activity 2 40.0% 1 20.0% 4 40.0% 4 40.0% 3 30.0% 3 30.0%

At least one hour of outdoor 

play daily 3 60.0 2 40.0 3 30.0 4 40.0 4 40.0 7 70.0

Less than one hour of outdoor 

play daily 0 0.0 2 40.0 2 20.0 1 10.0 2 20.0 0 0.0

Outdoor play daily (amount of 

time unspecified) 0 0.0 0 0.0 1 10.0 1 10.0 1 10.0 0 0.0
Shape NC Evaluation Report: Final Report

Table F-25. Type of indoor and outdoor physical activity

68

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Types of physical activities | 

children are involved in

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Indoor activity

Free play 0 0.0% 5 100.0% 5 50.0% 6 60.0% 6 60.0% 8 80.0%

Structured play/organized games 3 60.0 3 60.0 8 80.0 9 90.0 5 50.0 8 80.0

Sports 0 0.0 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0

Cardiovascular exercise 5 100.0 4 80.0 10 100.0 10 100.0 9 90.0 9 90.0

Balancing 2 40.0 2 40.0 5 50.0 3 30.0 1 10.0 3 30.0

Stretching 2 40.0 3 60.0 6 60.0 5 50.0 1 10.0 3 30.0

Outdoor activity

Free play 5 100.0 5 100.0 10 100.0 9 90.0 10 100.0 6 60.0

Structured play/organized games 3 60.0 5 100.0 8 80.0 7 70.0 4 40.0 6 60.0

Sports 1 20.0 3 60.0 5 50.0 5 50.0 6 60.0 2 20.0

Cardiovascular exercise 2 40.0 5 100.0 7 70.0 8 80.0 5 50.0 6 60.0

Climbing/sliding/swinging 4 80.0 4 80.0 8 80.0 8 80.0 9 90.0 9 90.0

Playing/building with loose toys 4 80.0 5 100.0 9 90.0 6 60.0 8 80.0 7 70.0

Riding bikes/riding toys 3 60.0 5 100.0 7 70.0 7 70.0 6 60.0 5 50.0

Balancing 0 0.0 2 40.0 4 40.0 4 40.0 3 30.0 2 20.0
Shape NC Evaluation Report: Final Report

Table F-26. Challenges reported by sites to promote physical activity

69

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). There were no statistically significant differences between baseline and follow-up for any of the groups. 

SOURCES: Director interview, fall 2017 and spring 2018; Director survey, fall 2018 and spring 2019. 

Challenges to physical activity

Treatment

2 years (n = 5)

Treatment

1 year (n = 10)

Comparison 

(n = 10)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

N % N % N % N % N % N %

Lack of staff training 4 80.0% 1 20.0% 8 80.0% 6 60.0% 4 40.0% 7 70.0%

Lack of appropriate physical 

education resources 4 80.0 2 40.0 8 80.0 6 60.0 7 70.0 8 80.0

Lack of funding to purchase 

equipment 3 60.0 2 40.0 7 70.0 5 50.0 4 40.0 7 70.0
Shape NC Evaluation Report: Final Report

Child Level Results

70

Table F-27. Average child BMI

NOTE: Findings for sites after one year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 

treatment sites that received treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

Table F-28. Percent of children in BMI weight category

NOTE: Percentages in the comparison column are based on data for sites that were in the comparison group in year 1 (cohort 2) and year 2 (cohort 3). Findings for sites after one 

year of treatment includes data from treatment sites in years 1 and 2. Findings for sites receiving two years of treatment includes cohort 1 treatment sites that received 

treatment in both years (year 1 and year 2). 

SOURCE: Child height and weight measurement, fall 2017, spring 2018, fall 2018, and spring 2019. 

BMI category

Treatment 

2 years

(n = 111)

Treatment 

1 year

(n = 447)

Comparison 

(n = 323)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Healthy weight 73.0% 67.6% 67.8% 70.3% 69.0% 69.7% 

Overweight 10.8 10.8 13.9 11.6 12.7 12.4 

Obese 11.7 15.3 13.0 12.1 13.9 9.9 

Underweight 4.5 6.3 5.4 6.0 4.3 8.1 

BMI category

Treatment 

2 years

(n = 111)

Treatment 

1 year

(n = 447)

Comparison 

(n = 323)

Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up

Overall 16.68 16.29 16.62 16.36 16.67 16.37 

Healthy weight 16.03 15.78 15.95 15.79 15.92 15.72 

Overweight 17.95 17.00 17.59 17.10 17.78 17.14 

Obese 20.63 19.65 20.38 19.60 20.36 19.64 

Underweight 13.89 14.11 13.45 13.90 13.59 14.00