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STARS (Start Taking Alcohol Risks Seriously) for Families

Ages 11-14

Rating: Level 2


STARS (Start Taking Alcohol Risks Seriously) for Families is a health promotion program for preventing alcohol use among at-risk middle and junior high school youths. The goal is for youths to postpone alcohol use until adulthood. The program is founded on the Multicomponent Motivational Stages prevention model, which is theoretically based in the Health Belief Model, the Social Learning Theory, and the Behavioral Self-Control Theory. STARS for Families matches media-related, interpersonal, and environmental prevention strategies to each child’s specific stages of alcohol initiation, stages of readiness for change, and specific risk and protective factors. The program has been tested and shown useful for youths ages 11 to 15 in both urban and rural schools, and for youths attending physical exams for sports teams.

The program has three phases:

  • Health Care Consultation. A nurse, health care provider, counselor, or social worker delivers a brief (20 minutes) annual health consultation concerning 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.
  • Key Facts Postcards. Eight Key Facts postcards are mailed to parents or guardians in sets of two per week for 4 weeks. The cards tell parents what they can say 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 four weekly take-home prevention activities for 4 weeks they can complete with their children and return. The lessons include an alcohol avoidance contract for the child to sign and a feedback sheet to collect satisfaction and usage data from parents.


One evaluation of the program examined a modified version of the STARS for Families program using a randomized controlled trial that tested the program’s feasibility and efficacy in physical examinations for school sports teams. The evaluation involved 178 seventh through ninth grade students from one urban, one suburban, and one rural school located in northeastern Florida. Participating youths were recruited by project staff and introduced to participating nurses during physicals for school sports programs. Most subjects were male (52 percent) and either white (75 percent) or African-American (13 percent), with a mean age of 13.1 years (SD=1.00). Subjects were randomly assigned to the intervention or a control group with a 6-month posttest.

A more comprehensive evaluation involved 650 sixth grade students in an experimental design with pretest and posttest. The students were from two schools in Jacksonville, Fla.—a magnet (bused) school and an innercity neighborhood school. Students were randomly assigned—half to the intervention group and half to the control group. A significant majority of the sample was African-American (85 percent), followed by white (12 percent). Seventy-nine percent of the sample (n=515) completed the posttest.


Six-month posttest outcomes for the sports physical examination study of the STARS for Families program, relative to the controls, included

  • Fewer youths planning to drink in the next 6 months
  • Fewer youths drinking alcohol in the past 30 days
  • Fewer youths drinking heavily during the past 30 days
  • Less heavy alcohol use

Posttest results from the sixth grade students showed

  • Fewer intervention youths (7 percent) were in more advanced stages of alcohol initiation
  • Intervention students had significantly fewer intentions to drink
  • The program significantly reduced alcohol consumption

Risk Factors


  • Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use
  • Poor refusal skills


  • Family history of the problem behavior/Parent criminality
  • Family management problems/Poor parental supervision and/or monitoring


  • Economic deprivation/Poverty/Residence in a disadvantaged neighborhood


  • Peer alcohol, tobacco, and/or other drug use

Protective Factors


  • Healthy / Conventional beliefs and clear standards
  • Perception of social support from adults and peers
  • Self-efficacy
  • Social competencies and problem-solving skills


  • Effective parenting
  • High expectations


  • Presence and involvement of caring, supportive adults


  • Presence and involvement of caring, supportive adults


  • Involvement with positive peer group activities


  • SAMHSA: Model Programs


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 Innercity 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.


Paula Jones
102 Highway 81 North, P.O. Box 9
Calhoun, KY 42327–0009
Phone: (800) 962-6662
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