Luis A. Moreno

Process Evaluation of the IDEFICS Intervention

Process evaluation is an essential part of intervention evaluation that is often overlooked or reported limitedly. This chapter explains in detail how the process evaluation within the IDEFICS study was developed and how the different measures were built. For each intervention module, different measures were developed to integrate multiple perspectives on the implementation. All measures were based on the framework of Linnan and Steckler (2002) to ensure a theory- and evidence-based approach. As process measures used in research are seldom reported in manuscripts, most of the measures were newly developed with the IDEFICS study itself. The measures itself are added to the chapter to share these instruments with other researchers so that they can build on our measures to develop their own.

CHAPTER 32:Bone Health: The Independent and Combined Effects of Calcium, Vitamin D and Exercise in Children and Adolescents

Early childhood and adolescence is considered the most important period for bone-mass optimization. Calcium, vitamin D and exercise play an important role on bone development during growth. In this chapter, we address the independent and combined effects of calcium and vitamin D and exercise on bone health in children and adolescents. Current research in this population indicates that both calcium and vitamin D intakes have a synergistic effect on bone mass and that adequate levels are necessary for normal bone mineralization. In addition, weight-bearing exercise has been shown to be a strong and positive predictor of bone health with evidence suggesting that its effect is enhanced when combined with adequate calcium and vitamin D intakes. While calcium, vitamin D and exercise are considered important modifiable factors of bone development, there is a need for further investigation on the interactions of these factors in order to improve bone development during the period of growth.