You probably won't be surprised to learn that the background of this image exists only in cyberspace. I was playing around with the "image hose" feature of Painter 4.0 - it's a "brush" that spews little copies of images. It comes with some pre-defined "nozzles" that can be used to fill areas with various kinds of clouds, foliage, and so on, like this:
To create my own nozzles I drew one each heart, star, moon, and mickey. Then for each I created about a dozen variations by rotating the image and adjusting its hues, and then added drop shadows. Presto, four image hose nozzles each of which can fill any area it's pointed at with a selection of hearts, stars, moons, or mickeys of any size. Painter is quite a powerful and fun program with lots of options; all it's lacking is a "good taste" adjustment...