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STARS for Families
Date of Review: March 2008

Start Taking Alcohol Risks Seriously (STARS) for Families is a health promotion program that aims to prevent or reduce alcohol use among middle school youth ages 11 to 14 years. The program is founded on the Multi-Component Motivational Stages (McMOS) prevention model, which is based on the stages of behavioral change found within the Transtheoretical Model of Change. The McMOS model posits a continuum of five stages in the initiation of alcohol use: precontemplation (has not tried alcohol in the past year), contemplation (is thinking about trying alcohol soon), preparation (is planning to start drinking soon), action (started drinking in the past 6 months), and maintenance (has been drinking for longer than 6 months). STARS for Families intervention materials are tailored to the individual's stage of alcohol use initiation.

STARS for Families has three components. Youth who participate in the program receive brief individual consultations in school or in after-school programs about why and how to avoid alcohol use, and they may also receive a follow-up consultation. These standardized sessions are provided by trained adults guided by protocols. A series of eight postcards are mailed to parents/guardians providing key facts about how to talk to their children about avoiding alcohol. In addition, the family completes four take-home lessons designed to enhance parent-child communication regarding prevention skills and knowledge. These three components can be implemented separately or in various combinations. In addition to its implementation in school and after-school settings, the program also has been used in health clinics, youth organizations, and homes.

Descriptive Info Outcomes Ratings Study Populations Studies/Materials Replications Contacts

Descriptive Information

Topics Substance abuse prevention
Areas of Interest Alcohol (e.g., underage, binge drinking) 
Outcomes Outcome 1: Heavy alcohol use
Outcome 2: Quantity of alcohol use
Outcome 3: Frequency of alcohol use
Outcome 4: Stage of alcohol use initiation
Outcome 5: Intentions to use alcohol in the future
Study Populations Age: 13-17 (Adolescent)
Gender: Female, Male
Race: Black or African American, White, Race/ethnicity unspecified
(See Study Populations section below for percentages by study)
Settings Rural and/or frontier, School, Suburban, Urban 
Implementation History STARS for Families, first implemented in 1993, has been used in eight schools and evaluated in nine studies. Nearly 1,300 students have received the intervention.  
ReplicationsThis intervention has been replicated. (See Replications section below)
Adaptations No population- or culture-specific adaptations were identified by the applicant.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the applicant.
Public or Proprietary Domain Proprietary
Costs The STARS for Families curriculum costs $299. It includes a complete facilitator's guide, 50 sets of 8 parent postcards, and 50 sets of 4 family take-home lessons. Additional sets of 50 parent postcards ($49.95) and 50 family take-home lessons ($129.95) can be purchased.

The cost of a 1-day, on-site training is $2,000 (plus travel expenses and meals) and includes one complete curriculum. Training participants may order additional copies of the curriculum for $250.

Program evaluation services cost $1,499 plus $2.50 for each short scannable student survey. These costs include scanning the surveys and providing a brief written report of data analysis results.  
Institute of Medicine Category Universal

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Outcomes

Outcome 1: Heavy alcohol use

Description of Measures The Youth Alcohol and Drug Survey was used to collect data on alcohol consumption. Heavy alcohol use was defined as consuming five or more drinks in a row during the past 2 weeks and past 30 days.
Key Findings In one study, at the 3-month posttest, fewer intervention participants reported drinking heavily during the past 30 days than participants in the comparison group, who received alcohol education booklets to read independently (p < .05). In another study, at the 6-month posttest, fewer intervention participants reported drinking heavily during the past 30 days than participants in the no-treatment control group (p < .05). In a third study, from baseline to the 3-month posttest, heavy drinking decreased in the intervention group and increased in the no-treatment control group (p < .05).
Studies Measuring Outcome Study 1, Study 3, Study 5
(Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)

Outcome 2: Quantity of alcohol use

Description of Measures A battery of standardized items was adopted from previous research on youth alcohol use prevention to assess the quantity of alcohol consumed during the past 30 days.
Key Findings At the 10-week follow-up, intervention participants reported having consumed less alcohol than participants in the comparison group, who received alcohol education booklets to read independently (p < .05).
Studies Measuring Outcome Study 4
(Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)

Outcome 3: Frequency of alcohol use

Description of Measures The Youth Alcohol and Drug Survey was used to collect data on the frequency of alcohol use during the past 7 days and past 30 days.
Key Findings

Three studies compared the intervention to a comparison condition in which participants received alcohol education booklets to read independently. In one study, at the 3-month posttest, fewer intervention participants reported drinking alcohol in the past 7 days (p < .05) and the past 30 days (p < .05) than participants in the comparison group. In another study, of participants who had already started using alcohol, those in the intervention group reported less frequent alcohol use at the 1-month posttest than those in the comparison group (p < .05). In a third study, at the 10-week follow-up, intervention participants reported significantly less frequent alcohol use over the past 30 days than comparison group participants (p < .05).

In another study, fewer participants in the intervention group than in the no-treatment control group reported at the 6-month posttest that they had consumed alcohol in the past 30 days (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3, Study 4
(Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)

Outcome 4: Stage of alcohol use initiation

Description of Measures The Youth Alcohol and Drug Survey was used to collect data on alcohol-related cognitive, social, and behavioral risk and protective factors. These data were used to assign participants to one of the five stages of alcohol use initiation: precontemplation, contemplation, preparation, action, and maintenance.
Key Findings At the 3-month posttest, fewer intervention participants were in the advanced stages of alcohol use initiation (i.e., preparation, action, maintenance) than participants in the comparison group, who received alcohol education booklets to read independently (p < .05).
Studies Measuring Outcome Study 1
(Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)

Outcome 5: Intentions to use alcohol in the future

Description of Measures The Youth Alcohol and Drug Survey was used to collect data on intentions to use alcohol in the future. Items measure intentions to drink in the next 6 months and intentions to think about using, plan to use, try to use, and use alcohol in the next year.
Key Findings In one study, at the 3-month posttest, intervention participants reported having significantly fewer intentions to drink alcohol in the future than students in the comparison group, who received alcohol education booklets to read independently (p < .01). This finding remained significant at the 1-year follow-up (p < .01). In another study, at the 6-month posttest, fewer participants in the intervention group than in the no-treatment control group reported intentions to use alcohol in the next 6 months (p < .05).
Studies Measuring Outcome Study 1, Study 3
(Study numbers correspond to the numbered citations in the Studies and Materials Reviewed section below)
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)

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Ratings

Quality of Research Ratings by Criteria (0.0-4.0 scale)

Outcome Reliability
of Measures		 Validity
of Measures		 Fidelity Missing
Data/Attrition		 Confounding
Variables		 Data
Analysis		 Overall
Rating
Outcome 1: Heavy alcohol use 3.5 2.5 2.5 2.5 2.5 4.0 2.9
Outcome 2: Quantity of alcohol use 3.5 3.0 2.5 2.5 3.5 4.0 3.2
Outcome 3: Frequency of alcohol use 3.5 3.0 3.0 2.5 3.5 4.0 3.3
Outcome 4: Stage of alcohol use initiation 3.5 3.0 2.5 2.5 3.5 4.0 3.2
Outcome 5: Intentions to use alcohol in the future 3.5 2.5 3.0 2.5 2.5 3.5 2.9

Study Strengths: The studies used randomized designs. The measures were reliable, and self-report measures of alcohol use were validated with saliva dipstick tests. The analyses were appropriate.

Study Weaknesses: Some of the studies did not sufficiently address intervention fidelity. One of the instruments used did not have known psychometric properties. Some of the studies did not clearly explain whether the parents' involvement in the intervention was as intended. Contamination across treatment conditions was possible in some studies. In some cases, attrition was high and there were differences in baseline alcohol use between students who completed the program and those who did not.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

Implementation
Materials		 Training
and Support		 Quality
Assurance		 Overall
Rating
3.0 2.5 3.5 3.0

Dissemination Strengths: Implementation guidelines supplement the well-designed core program materials. Parent materials are brief and easily accessible. An on-site training relying heavily on role-play techniques is available to program implementers, and additional support from the training facilitator is available after the training by phone or e-mail. Process and outcome measures are provided to support quality assurance.

Dissemination Weaknesses: No information is provided to support program administrators in assessing site readiness, recruiting an implementation team, or identifying program participants. Training includes limited discussion of strategies for relating to adolescents or handling difficult situations. No systematic coaching is available for implementers. It is unclear how some quality assurance tools fit into the overall quality assurance process.

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Study Populations

The studies reviewed for this intervention included the following populations, as reported by the study authors.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent)
 50% Female
50% Male
 85% Black or African American
12% White
3% Race/ethnicity unspecified
Study 2 13-17 (Adolescent)
 50% Female
50% Male
 85% Black or African American
12% White
3% Race/ethnicity unspecified
Study 3 13-17 (Adolescent)
 51.7% Male
48.3% Female
 74.7% White
13.5% Black or African American
11.8% Race/ethnicity unspecified
Study 4 13-17 (Adolescent)
 56% Female
44% Male
 88% Black or African American
10% White
2% Race/ethnicity unspecified
Study 5 13-17 (Adolescent)
 59% Female
41% Male
 84% Black or African American
13% White
3% Race/ethnicity unspecified

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Studies and Materials Reviewed

The documents below were reviewed for Quality of Research and Readiness for Dissemination. Other materials may be available. For more information, contact the person(s) listed at the end of this summary.

Quality of Research Studies

Study 1

Werch, C. E., Carlson, J. M., Owen, D. M., DiClemente, C. C., & Carbonari, J. P. (2001). Effects of a stage-based alcohol preventive intervention for inner-city youth. Journal of Drug Education, 31(2), 123-138. Pub Med icon

Werch, C. E., Owen, D. M., Carlson, J. M., DiClemente, C. C., Edgemon, P., & Moore, M. (2003). One-year follow-up results of the STARS for Families alcohol prevention program. Health Education Research, 18(1), 74-87. Pub Med icon

Werch, C. E., Pappas, D. M., Carlson, J. M., Edgemon, P., Sinder, J. A., & DiClemente, C. C. (2000). Evaluation of a brief alcohol prevention program for urban school youth. American Journal of Health Behavior, 24(2), 120-131.

Study 2

Werch, C. E., Pappas, D. M., Carlson, J. M., & DiClemente, C. C. (1998). Short- and long-term effects of a pilot prevention program to reduce alcohol consumption. Substance Use and Misuse, 33(11), 2303-2321. Pub Med icon

Study 3

Werch, C. E., Carlson, J. M., Pappas, D. M., Edgemon, P., & DiClemente, C. C. (2000). Effects of a brief alcohol preventive intervention for youth attending school sports physical examinations. Substance Use and Misuse, 35(3), 421-432. Pub Med icon

Study 4

Werch, C. E., Anzalone, D. M., Brokiewicz, L. M., Felker, J., Carlson, J. M., & Castellon-Vogel, E. A. (1996). An intervention for preventing alcohol use among inner-city middle school students. Archives of Family Medicine, 5(3), 146-152. Pub Med icon

Study 5

Werch, C. E., Carlson, J. M., Pappas, D. M., & DiClemente, C. C. (1996). Brief nurse consultations for preventing alcohol use among urban school youth. Journal of School Health, 66(9), 335-338. Pub Med icon

Readiness for Dissemination Materials

STARS for Families training [PowerPoint presentation]

STARS for Families training information sheet

Werch, C. E., & Carlson, J. M. (n.d.). STARS for Families: Connecting schools, homes and communities in at-risk alcohol prevention. Calhoun, KY: NIMCO.

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Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Werch, C. E., Carlson, J. M., Owen, D. M., DiClemente, C. C., & Carbonari, J. P. (2001). Effects of a stage-based alcohol preventive intervention for inner-city youth. Journal of Drug Education, 31(2), 123-138. Pub Med icon

* Werch, C. E., Carlson, J. M., Pappas, D. M., & DiClemente, C. C. (1996). Brief nurse consultations for preventing alcohol use among urban school youth. Journal of School Health, 66(9), 335-338. Pub Med icon

* Werch, C. E., Pappas, D. M., Carlson, J. M., Edgemon, P., Sinder, J. A., & DiClemente, C. C. (2000). Evaluation of a brief alcohol prevention program for urban school youth. American Journal of Health Behavior, 24(2), 120-131.

* Werch, C. E., Pappas, D. M., Carlson, J. M., & DiClemente, C. C. (1998). Short- and long-term effects of a pilot prevention program to reduce alcohol consumption. Substance Use and Misuse, 33(11), 2303-2321. Pub Med icon

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Contact Information

Web site(s):

http://briefprograms.com

For information about implementation:

Dinky Hicks
NIMCO, Incorporated
P.O. Box 9
Calhoun, Kentucky 42327-0009
Phone: (800) 962-6662
E-mail: dinky@nimcoinc.com

Paula Jones
NIMCO, Incorporated
P.O. Box 9
Calhoun, Kentucky 42327-0009
Phone: (800) 962-6662
E-mail: paula@nimcoinc.com

For information about studies:

Chad Werch, Ph.D.
Founder and Research Scientist
Brief Programs for Health, LLC
3595 Forest Bend Terrace
Jacksonville, FL 32224
Phone: (904) 472-5022
E-mail: cwerch@briefprograms.com; cwerch@hhp.ufl.edu

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The NREPP review of this intervention was funded by the Center for Substance Abuse Prevention (CSAP).