Effectiveness of Fresh Start: A Randomized Study of a School-Based Program to Retain a Negative Attitude Toward Substance Use in Secondary School Freshmen

ABSTRACT

Background: The transition to secondary school is linked to more positive attitudes toward substance use, which prelude the moment of first use. Fresh Start is a school-based prevention program for secondary school freshmen (12–13 years old) to retain negative attitudes. Objectives: This study evaluates the effectiveness of Fresh Start on the attitudes toward smoking, alcohol use, and cannabis use, and on multiple secondary outcome measures. In addition, the effect of timing of the program within the schoolyear was examined. Methods: A cluster randomized trial was conducted. 48 classes, containing 1083 secondary school freshmen, were randomly allocated to the experimental or waiting list control condition. Experimental classes completed Fresh Start between October 2015 and January 2016 and waiting list control classes completed Fresh Start between March 2016 and May 2016. Measurements were scheduled at three points in time (September 2015, February 2016, and June 2016). Data were analyzed by means of multilevel analyses. Results: Fresh Start had small but significant effects on the attitudes toward smoking, alcohol use and cannabis use. The majority of secondary outcome measures were not influenced by Fresh Start, although a small, adverse effect was found on the perceived social acceptance of cannabis use by friends. Timing of the intervention within the schoolyear did not influence its effectiveness. Conclusions/Importance: Fresh Start can help to delay the development of positive attitudes toward substance use in secondary school freshmen. Strengths and limitations, implications for practice and suggestions for future research are discussed.

KEYWORDS:

• Adolescence
• alcohol
• attitude
• cannabis
• cluster randomized trial
• smoking
• substance use

Declaration of interest

Although SO, AH, and PS did not develop Fresh Start, they are employed by the same organization. AZ has no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Funding

Funding for this study was provided by the Dutch Ministry of Health, Welfare and Sports. The Dutch Ministry of Health, Welfare and Sports had no involvement in the study design, collection, analysis, or interpretation of data, writing the manuscript, and the decision to submit the manuscript for publication.