Program Profile: New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR)

This is a prevention planning and implementation system designed to improve risk and protective factors, and reduce secretive problems, in military communities. The program is rated No Effects. There were no statistically significant differences between the bases assigned to NORTH STAR and the comparison bases on measures of physical or emotional interpersonal violence/partner abuse, physical or emotional child abuse, hazardous drinking, suicidality, or prescription drug misuse.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR) is a prevention planning and implementation system designed to improve risk and protective factors, as well as reduce secretive problems, in military communities through the implementation of evidence-based interventions. Secretive problems are behavioral problems such as child abuse and intimate-partner violence, substance misuse, and suicidality, which is experienced by active-duty military members who are unknown to others in uniform. NORTH STAR guides prevention leaders through a community needs assessment, using the results of the needs assessment to select risk and protective factors to target, implement evidence-based programming to target the selected risk and protective factors, and evaluate the impact. As such, NORTH STAR is not a program, but instead a community-wide framework for targeting interconnected problems among active military members, specifically those in the Air Force (Slep et al., 2020; Slep et al., 2021).

Program Theory

NORTH STAR is based on the premise that secretive problems are interconnected and share a handful of similar risk and protective factors. Thus, targeting these overlapping risk and protective factors in a consolidated, community-based intervention allows for high-risk individuals to avoid being identified and referred to stigmatized services.

Further, as a population-level intervention, in addition to those individuals who directly participate in the intervention, individuals who do not participate in an intervention can also indirectly benefit. This indirect benefit might be influenced by numerous factors, such as modeling healthier behaviors, social contagion, or a shift in norms around healthy and unhealth behaviors (Slep et al. 2020; Slep et al. 2021).  

Program Components

NORTH STAR is implemented on Air Force bases by Community Action Teams (CATs). CATs are taught to use data to select and implement evidence-based interventions that should improve the risk and protective factors of the community. To implement NORTH STAR, CATs receive a 1½-day onsite training, which reviews the results of the base’s feedback report. The feedback report includes the prevalence of the base’s secretive problems, as well as information on individuals’ risk and protective factors. After reviewing the feedback report, CATs develop an action plan that prioritizes risk and protective factors to target. Once the risk and protective factors are selected, the CAT would reference the NORTH STAR Guidebook, which consists of programs that 1) target risk and protective factors, 2) could be implemented on a large scale, and 3) are available for implementation. The final plan includes up to two programs that target two to three risk and protective factors. The targeted risk and protective factors include depressive symptoms, personal and family coping, intimate and parent–child relationship satisfaction, and physical activity (Slep et al. 2020; Slep et al. 2021).

Study 1

Slep and colleagues (2020) used a randomized experimental design (at the air base level) to compare the outcomes of individuals on Air Force bases which had been randomly assigned to deliver New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR) versus individuals on Air Force bases that were randomly assigned to the control group.

To recruit participants, Air Force prevention teams met with behavioral points of contact from Air Force Major Commands. The Air Force points of contact then met with installation-level counterparts to determine interest. Installations from Major Commands were accepted until the study reached the required number of installations. Of the 79 Air Force installations with Community Action Teams (CATs), 24 volunteered and enrolled in the study.

Data for this study came from the Community Assessments that were administered to all active-duty members and their spouses on the participating bases in 2006 and 2008. From April 2006 to June 2006, 16,020 active-duty members and 4,833 spouses at the 24 participating bases completed the online Community Assessments. From April to June 2008, 16,998 active-duty members and 3,410 spouses at the participating bases completed the online Community Assessments. Analyses including individual-level outcomes were restricted to active-duty members (n = 33,018). Analyses including family outcomes were limited to individuals who were in romantic relationships or had children; thus, this analysis included both active-duty members and spouses (n = 35,297). However, in cases in which both the active-duty member and the spouse participated in the survey, the spouse was selected for analysis. 

The active-duty?only sample was 73.2 percent male, with an average age of 32 years. Sixty-seven percent were married, 53 percent were parents, and 22 percent were officers. The active-duty member or spouse sample was 58 percent male, with an average age of 33. Eighty-five percent were married, 65 percent were parents, and 24 percent were officers.

Assigning the bases to NORTH STAR versus the control group was done using Microsoft Excel?s random number generator. The control group received enhanced feedback; in other words, control bases were sent detailed feedback of their Community Assessment results. This also was provided to NORTH STAR bases; however, in the control condition no additional training or explanation of the results was provided.

The outcomes of interest included secretive problems, hazardous drinking, controlled prescription drug misuse, suicidality, clinically significant interpersonal violence (IPV) and child abuse (emotional and physical), and cumulative risk (however, the CrimeSolutions review of this study focused on the impact of NORTH STAR on hazardous drinking, controlled prescription drug misuse, suicidality, physical clinically significant IPV, physical clinically significant child abuse, emotional clinically significant IPV, and emotional clinically significant child abuse). Hazardous drinking was measured using the Alcohol use Disorders Identification Test, which is a 10-item self-report measure of alcohol dependence. Controlled prescription drug misuse was measured by participants completing a checklist of commonly abused controlled prescription medications, indicating their frequency of use. Suicidality was measured with four items from the Youth Risk Behavior Survey. Finally, physical clinically significant IPV, physical clinically significant child abuse, emotional clinically significant IPV, and emotional clinically significant child abuse were measured using the Family Maltreatment measure.

The study used repeated cross-sectional surveys that sampled each participating community at multiple time points. Multilevel analysis with robust maximum likelihood estimation was used to measure the impact of NORTH STAR in independent samples of people within each base in 2006 and 2008. The unit of analysis was individuals. Individual-level outcomes were analyzed using the active-duty sample, while family-level outcomes (physical clinically significant IPV, physical clinically significant child abuse, emotional clinically significant IPV, and emotional clinically significant child abuse) were measured with the active-duty members and spouse sample. No subgroup analysis was conducted.

Study 2

Slep and colleagues (2021) used the same randomized experimental design as Study 1 (Slep et al. 2020); however, in Study 2, the unit of analysis was bases, rather than individuals. The study compared the outcomes of Air Force bases assigned to NORTH STAR (n = 12 bases) with bases that were assigned to the control group (n = 12 bases). As such, the data, the sample, the randomization procedure, and the outcomes of interest are the same in Study 1 and Study 2. The primary difference between the studies is that analysis of the outcome data was conducted at the individual-level in Study 1 and conducted at the base-level in Study 2.

To measure the outcomes of interest, the study used repeated cross-sectional surveys that sampled each participating community at multiple time points. Logistic regression models were used to estimate bases? changes in outcomes. Individual-level outcomes were analyzed using the active-duty sample, while family-level outcomes (physical clinically significant IPV, physical clinically significant child abuse, emotional clinically significant IPV, and emotional clinically significant child abuse) were measured with the active-duty members and spouse sample. No subgroup analysis was conducted.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: