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.
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.
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.
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.
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 Caucasian, 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 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.
Werch and colleagues (2003) recruited 650 sixth grade students to participate in their study in the fall of 1996. The intervention took place in two middle schools located in urban, economically disadvantaged neighborhoods in Jacksonville, Florida. The students attended a magnet and a neighborhood school in the inner city. Students in both schools were randomized to receive either a minimal intervention control in the shape of two alcohol education booklets (one in the fall semester of each year), or to participate in the STARS for Families intervention, which took place over 2 years. Most students were African-American (58 percent), with 34 percent Caucasian participants, and 8 percent other ethnicities. The mean age of participants was 11.40 years at baseline and a little over half of the participants (54 percent) were male. Fifty-five percent of students qualified for the free lunch program and 31 percent reported a perceived alcohol or drug problem in their immediate family. 42 percent reported not having received alcohol and drug education in the prior year.
The participants completed the Youth Alcohol and Drug Survey to measure alcohol use, frequency of use, and risk of use, as well as attitudes, beliefs, and intentions. Data were collected at a 1-year follow-up at the end of the students’ eighth grade year.
At the 1-year follow-up, 250 intervention and 257 control students completed the survey. In the neighborhood school, 100 intervention and 107 control students’ surveys were analyzed. In the magnet school, 150 intervention and 150 control student’s responses were analyzed. Data were analyzed using chi squares, multiple analyses of variance (MANOVA), and multiple analyses of covariance (MANCOVA).
Rates of Alcohol Use
Werch and colleagues (1998) found no significant differences between the STARS (Start Taking Alcohol Risks Seriously) for Families intervention and control groups in their alcohol use at posttest or at the 1-year follow-up. Additionally, no statistically significant differences were found in rates of heavy alcohol use between both groups at all post-baseline measurements.
Frequency of Alcohol Use
There were no statistically significant differences between the intervention and control groups at any follow-up points in terms of frequency of alcohol use. A subanalysis of only current drinkers found that intervention group drinkers used alcohol significantly less frequently than control group drinkers at the posttest. This finding, however, was not observed at the 1-year follow-up.
Rates of Alcohol Use
Werch and colleagues (2003) found no significant difference between the intervention and control groups in their alcohol use at the 1-year follow-up. Additionally, no statistically significant differences were found in rates of heavy alcohol use in either intervention or control group.
Frequency of Alcohol Use
There were no statistically significant differences between the intervention and control groups at the 1-year follow-up in terms of frequency of use.
Intentions, Risk, and Motivation
The authors found inconsistent evidence of programmatic effects in terms of alcohol intentions, with a significant effect in the neighborhood school intervention group exhibiting lower alcohol intentions than their control group. However, this result was not found in the magnet school intervention group. Conversely, total alcohol risks were found to be significantly lower in the magnet school intervention group at the 1-year follow-up, a finding not observed in the neighborhood school intervention group. Similarly, only the magnet school intervention group had significantly higher motivation compared to its respective control group at the 1-year follow-up. This finding was not observed in the neighborhood school intervention group.
Peer Prevalence, Influenceability, and Beliefs
The study found no significant differences between treatment and control groups at the 1-year follow-up in terms of either influenceability, peer prevalence of alcohol use, or expectancy beliefs.