Prevention Science, Vol. 5, No. 3, September 2004 (
Students’ Special Needs and Problems as Reasons
for the Adaptation of Substance Abuse Prevention
Curricula in the Nation’s Middle Schools
Susan T. Ennett,
and Ashley Simons-Rudolph
In this study we estimate the proportion of the nation’s middle school teachers who have
adapted substance abuse curricula in response to their students’ special problems or needs.
We also explore a variety of characteristics associated with schools, teachers, and the curricula
implemented that are associated with adaptations made in response to the most prevalent
of these student problems or needs. Study data were collected in 1999 from a representative
sample of lead substance abuse prevention teachers in the nation’s public and private schools.
We found that 79.8% of respondents report adapting their prevention curricula in response
to at least one of the dozen student problems and needs speciﬁed. The problems cited most
frequently, by slightly more than half of all respondents, relate to the needs of students who
are sexually active or have discipline problems. Associated most strongly with adaptations for
these two reasons were teachers who were recently trained in their curricula, and substance
abuse prevention lessons that could readily be integrated into the school’s overall curriculum.
We discuss the need for curriculum developers to recognize the frequency with which, and
reasons for which, teachers are adapting their curricula, and to include appropriate optional
content that addresses students’ needs.
KEY WORDS: adaptation; curricula; substance abuse prevention.
There is now considerable evidence that the
adaptation of classroom-based substance use pre-
vention curricula in the nation’s middle schools is
widespread. As early as the mid-1970s the RAND
Corporation reported that innovative programs are
only rarely implemented with complete ﬁdelity
(Berman & McLaughlin, 1976). More recently, an as-
sessment of the “Here’s Looking at You II” curricu-
Chapel Hill Center, Paciﬁc Institute for Research and Evaluation.
Department of Health Behavior & Health Education, School of
Public Health, University of North Carolina at Chapel Hill.
Center for Interdisciplinary Substance Abuse Research, RTI
Correspondence should be directed to Chris Ringwalt, Chapel
Hill Center, Paciﬁc Institute for Research & Evaluation, 1516 E.
Franklin St., Suite 200, Chapel Hill, North Carolina 27514-2812;
lum found that, in one of three school districts studied,
teachers implemented only half the number of lessons
speciﬁed (Tricker & Davis, 1988). Results of another
study showed that 84% of teachers omitted at least
one of the modules included in the “Teenage Health
Teaching Modules” curriculum, and were more likely
to omit such critical curricular elements as role playing
and family communication (Tappe et al., 1995). In a
recent evaluation of Life Skills Training, Botvin et al.,
(2001) found that slightly less than half the program
points speciﬁed were actually covered in the class-
room. A national survey of a representative sample
of lead substance use prevention teachers, conducted
in 1999, suggests that as few as 15% report that they
follow curriculum guides very closely (Ringwalt et al.,
The issue of program adaptation is of grow-
ing importance and concern because agencies fund-
ing substance use prevention (e.g., U.S. Department
2004 Society for Prevention Research