Program Profile: STARS (Start Taking Alcohol Risks Seriously) for Families

This is a health promotion program designed to prevent alcohol use among at-risk middle and junior high school youth. The goal is to postpone alcohol use until adulthood. The program seeks to identify the various risk factors that youth are exposed to and offer them targeted information concerning underage alcohol use. The program is rated Ineffective. There were no statistically significant effects on frequency of alcohol use, quantity of alcohol consumption, or heavy alcohol use.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

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

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

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

Program Goals

STARS (Start Taking Alcohol Risks Seriously) for Families is a health promotion program designed to prevent alcohol use among at-risk middle and junior high school youths. The goal is to postpone alcohol use until adulthood. The program aims to identify the various risk factors that youths are exposed to and offer them targeted information concerning underage alcohol use. It encourages participants to recognize situations and peer influences that may lead to alcohol consumption, to understand the health risks and perceived “benefits” associated with alcohol use, and to pledge to abstain from using alcohol.

Program Theory

The program is based on the Multicomponent Motivational Stages prevention model, which is theoretically steeped in the Health Belief Model, the Social Learning Theory, and the Behavioral Self-Control Theory.

Target Population

The program is designed for youths between the ages of 11 and 15, and specifically addresses problems of youth alcohol initiation in disadvantaged urban neighborhoods. The program is also offered to youths attending physical exams for sports teams, as these health-related examinations blend well with program components.

Program Components

STARS for Families matches media-related, interpersonal, and environmental prevention strategies to each youth’s specific stages of alcohol initiation and readiness for change, as well as specific risk and protective factors.

The program has three phases:

• Health Care Consultation. A nurse, health care provider, counselor, or social worker delivers a brief (20 minute) annual health consultation on how to avoid alcohol use. The intervention is designed to reach youths at specific stages of alcohol initiation and readiness for change and provides a range of prevention messages. It also assesses the risk factors that each child presents, catering subsequent components to each participant.
• Key Facts Postcards. Key Facts postcards are mailed to parents or guardians. The cards instruct parents on how and what to communicate to their children to help them avoid alcohol. Parents can return a detachable postage-paid portion of the card to provide information about their interaction with their children and its usefulness.
• Family Take-Home Lessons. Parents and guardians are provided with weekly take-home prevention activities they can complete with their children and return to program staff. The lessons include an alcohol avoidance contract for the child to sign and a feedback sheet to collect satisfaction and usage data from parents.

Study

Werch and colleagues (1998) recruited students to their study from the sixth grade at a middle school in a disadvantaged Jacksonville, Florida inner city school district in the fall of 1995. After returning their parental consent form, the pilot study recruited 85 percent of eligible students. Eight additional students did not complete the baseline (either withdrawing from the study, being transferred, suspended, or expelled). The 211 participating students were 85 percent African American, 12 percent white, and 3 percent other ethnicities, with half of the students being male. The mean age of participants at baseline was 12.08 years, with 78 percent of students participating in the free lunch program—an indication of social disadvantage. Additionally, 32 percent of participants reported an immediate family member with a drug or alcohol problem and 65 percent reported not having received any drug or alcohol education in the preceding year. They were randomly assigned by computer to receive either STARS (Start Taking Alcohol Risks Seriously) for Families or to a control condition that received a 15-page alcohol education booklet. For the intervention group, the treatment delivered depended on the risk factors identified during the healthcare consultation, with students receiving between two and nine family lessons. The average number of lessons received by students was 5.5.

At a 1-month posttest, 187 subjects participated, with 147 participating at the 1-year follow-up. Significant differences existed between dropouts and participants in terms of baseline measures of free lunches, age, and alcohol use. At the posttest, the authors tested 88 intervention and 99 control students. At the 1-year follow-up, 73 students in the treatment group were compared to 70 students in the control group using t-tests, chi squares, and analyses of covariance (ANCOVA).

The authors used the 77 item Youth Alcohol and Drug Survey to measure alcohol and drug consumption, in terms of frequency and intensity, as well as risk and protective factors. Additional demographic data were also collected, including age, ethnicity, participation in free lunch programs, exposure to alcohol and drug problems, and other education programs, and parental education level. Subgroup analyses were conducted to determine the potential impact of the program on current drinkers.

Subgroup Analysis

Werch and colleagues (1998) conducted subgroup analyses to examine the potential effects of the program on current drinkers. There were no statistically significant differences found between current drinkers in the STARS (Start Taking Alcohol Risks Seriously) for Families intervention group and current drinkers in the control group in frequency of alcohol use, quantity of alcohol consumed, or heavy alcohol use at the 1-year follow up.

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

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

Werch, Chudley E., and Debra Anzalone. 1995. “Stage Theory and Research on Tobacco, Alcohol, and Other Drug Use.” Journal of Drug Education 25(2):81–98.

Werch, Chudley E., Debra Anzalone, Eduardo A. Castellon–Vogel, Joan M. Carlson, Lynn M. Brokiewicz, and Jennifer Felker. 1995. “Factors Associated With the Stages of Alcohol Use Among Inner City School Youth.” Journal of School Health 65(7):255–59.

Werch, Chudley E., Joan M. Carlson, Deborah M. Pappas, and Carlo C. DiClemente. 1996. “Brief Nurse Consultations for Preventing Alcohol Use Among Urban School Youth.” Journal of School Health 66(9):335–38.

Werch, Chudley E., Joan M. Carlson, Deborah M. Pappas, Michael Dunn, and Teresa Williams. 1997. “Risk Factors Related to Urban Youth Stage of Alcohol Initiation.” American Journal of Health Behavior 21(5):377–87.

Werch, Chudley E., and Carlo C. DiClemente. 1994. “A Multicomponent Stage Model for Matching Drug Prevention Strategies to Youth Stage of Use.” Health Education Research: Theory and Practice 9(1):37–46.

Werch, Chudley E., and Dean R. Gorman. 1986. “Factor Analysis of Internal and External Self-Control Practices for Alcohol Consumption.” Psychological Reports 59:1207–13.

Werch, Chudley E., Betty W. Meers, and Joan Farrell. 1993. “Stages of Drug Use Acquisition Among College Students: Implications for the Prevention of Drug Abuse.” Journal of Drug Education 23:375–726.

Werch, Chudley E., Deborah M. Pappas, Joan M. Carlson, Patricia Edgemon, Jacqueline A. Sinder, and Carlo C. DiClemente. 2000. “Evaluation of a Brief Alcohol Prevention Program for Urban School Youth.” American Journal of Health Behavior 24(2):120–31.

Werch, Chudley E., Michael Young, Margo Clark, Carol Garrett, Sarah Hooks, and Carolyn Kersten. 1991. “Effects of a Take-Home Drug Prevention Program on Drug-Related Communication and Beliefs of Parents and Children.” Journal of School Health 61:346–50.

Werch, Chudley E., Joan M. Carlson, Deborah M. Pappas, Patricia Edgemon, and Carlo C. DiClemente. 2000. “Effects of a Brief Alcohol Preventive Intervention for Youth Attending School Sports Physical Examinations.” Substance Use & Misuse 35(3):421–32.

Werch, Chudley E., Joan M. Carlson, Deborah M. Owen, Carlo C. DiClemente, and Joseph P. Carbonari. 2001. “Effects of a Stage-Based Alcohol Preventive Intervention for Inner City Youth.” Journal of Drug Education 31(2):123–38.

Werch, Chudley E., Deborah M. Owen, Joan M. Carlson, Carlo C. DiClemente, Patricia Edgemon, and Michelle J. Moore. 2003. “One-year Follow-up Results of the STARS for Families Alcohol Prevention Program.” Health Education Research 18(1):74–87.