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Family Matters

Ages 12-14

Rating: Level 1


Family Matters is a family-directed program that reduces tobacco and alcohol use among 12- to 14-year-olds. The intervention is delivered through four booklets mailed to the home and through follow-up telephone calls by health educators. The booklets contain lessons and activities designed to motivate families to participate in the program and encourage families to consider characteristics related to adolescent substance use. Booklet content includes communication skills, parenting styles, attachment and time together, educational encouragement, conflict resolution, availability of tobacco and alcohol in the home, family rules about child use of tobacco and alcohol, and insights into peer and media influences.

Four booklets are successively mailed home to parents, along with token participation incentives of a Family Matters–imprinted pencil, button, balloon, or magnet. After each mailing, health educators phone parents to encourage them to complete the book and any included parent–child activities, and to answer questions. Each booklet contains information based on behavioral science theory and research and includes participant activities. The booklets, in order of delivery, are

  • Why Families Matter, which describes the program and encourages participation.
  • Helping Families Matter to Teens. This considers general family factors such as communication skills and parenting styles, which influence adolescent alcohol and tobacco use.
  • Alcohol and Tobacco Rules Are Family Matters emphasizes behavior-specific factors that families can influence, including the availability of tobacco and alcohol in the home and family rules about child substance use.
  • Nonfamily Influences That Matter deals with nonfamily influences on adolescent substance use, such as friends who use and the media. It also reviews the main points of the program.

The adolescent’s mother or mother surrogate usually is the program contact. She is asked to participate in the program and to involve additional adult family members. Adult family members are asked, in addition to reading the booklet, to complete activities with the adolescent that exercise key program content areas such as communication skills and rule setting. Some of the reading material and activities are for adult family members only, while other parts of the program are for the adult family members and the adolescent. The health educators who conduct follow-up calls after each booklet is completed never interact directly with the adolescent as part of program delivery. Health educators can be culled from within the implementing organization or surrounding community (school nurses, teachers, college students, business professionals are all candidates). Health care educators can be paid staff or volunteers.

The four booklets and the Health Educators Manual, which include health educator protocols for each unit, are available at


Family Matters was evaluated through a randomized experimental design. At baseline, parent–child pairs (with the child always 12 to 14) were selected throughout the United States by random-digit dialing and then interviewed by telephone. Initially, 64,811 telephone numbers were selected to represent all residential phone numbers in the contiguous United States, of which 2,395 were estimated to be in households with both an eligible adolescent and parent. A total of 1,326, or 55.4 percent, of the adolescents and their parents completed 15-minute baseline telephone interviews. Ultimately, 1,316 subjects made up the final sample, as 9 asked to be withdrawn and 1 was lost to follow-up.

Next the adolescents and their families were randomly allocated either to receive Family Matters or to serve as controls. At 3- and 12-month points after the program was completed, follow-up telephone interviews were completed with 1,135 of the 1,316 parent–child pairs interviewed at baseline (531 were in the treatment group, and 604 were controls). Multivariate statistical analyses were conducted to assess program effects for self-reported adolescent cigarette smoking and alcohol use. Multivariate analyses also were conducted to examine the mechanisms through which program effects for behavior were expected to occur, to assess determinants of program participation, and to assess other program-related issues.


The evaluation data illustrates decreases in substance use, such as reduced adolescent cigarette smoking and reduced adolescent alcohol use. The effect sizes at 3 and 12 months postprogram were modest but compared favorably with the average effect sizes found for the most effective school-based drug curricula studies with randomized experimental designs.

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
  • Poor family attachment/Bonding


  • Low academic achievement


  • Availability of alcohol and other drugs


  • Association with delinquent and/or aggressive peers
  • Peer alcohol, tobacco, and/or other drug use

Protective Factors


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


  • Effective parenting
  • Good relationships with parents / Bonding or attachment to family
  • High expectations
  • Opportunities for prosocial family involvement
  • Rewards for prosocial family involvement


  • Above average academic achievement / Reading and math skills


  • Good relationships with peers
  • Involvement with positive peer group activities
  • Parental approval of friends


  • SAMHSA: Model Programs


Bauman, Karl E., Susan T. Ennett, Vangie Ann Foshee, Michael Pemberton, and Katherine A. Hicks. 2001. “Correlates of Participation in a Family-Directed Tobacco and Alcohol Prevention Program for Adolescents.” Health Education and Behavior 28(4):440–61.

Bauman Karl E., Susan T. Ennett, Vangie Ann Foshee, Michael Pemberton, Tonya S. King, and Gary G. Koch. 2000. “Influence of a Family-Directed Program on Adolescent Cigarette and Alcohol Cessation.” Prevention Science 1(4):227–37.

———. 2002. “Influence of a Family Program on Adolescent Smoking and Drinking Prevalence.” Prevention Science 3:35–42.

Bauman, Karl E., Vangie Ann Foshee, Susan T. Ennett, Katherine A. Hicks, and Michael Pemberton. 2001. “Family Matters: A Family-Directed Program Designed to Prevent Adolescent Tobacco and Alcohol Use.” Health Promotion Practice 2(1):81–96.

Bauman, Karl E., Vangie Ann Foshee, Susan T. Ennett, Michael Pemberton, Katherine A. Hicks, Tonya S. King, and Gary G. Koch. 2001. “Influence of a Family Program on Adolescent Tobacco and Alcohol Use.” American Journal of Public Health 91(4):604–10.

Ennett, Susan T., Karl E. Bauman, Vangie Ann Foshee, Michael Pemberton, and Katherine A. Hicks. 2001. “Parent–Child Communication About Adolescent Tobacco and Alcohol Use: What Do Parents Say and Does It Affect Youth Behavior?” Journal of Marriage and the Family 63:48–62.

Ennett, Susan T., Karl E. Bauman, Michael Pemberton, Vangie Ann Foshee, Ying–Chih Chuang, Tonya S. King, and Gary G. Koch. 2001. “Mediation in a Family-Directed Program for Prevention of Adolescent Tobacco and Alcohol Use.” Preventive Medicine 33(4):333–46.


Karl E. Bauman, Ph.D.
116 Nolen Lane
Chapel Hill, NC 27516
Web site:

Technical Assistance Provider

Karl E. Bauman, Ph.D.
116 Nolen Lane
Chapel Hill, NC 27516
Web site: