The predominately rural state of Mississippi responded to high teenage pregnancy rates by enacting a 2011 law requiring school districts to choose between an abstinence-only and an abstinence-plus program for their high schools. However, there is limited extant research on Mississippi's sex education policies, creating a research gap that inhibits developing successful programs to reduce teenage pregnancy rates. There is specifically a need to compare the two types of allowed programs with a focus on rural areas. This study compared programs by examining students' abstinent sexual attitudes, social norms, self-efficacy, sexual abstinence behaviors, and perceived effectiveness of sexual education and decision making to address whether those variables differed by program and if programs and genders interacted. The study was informed by the health belief model, social cognitive theory, and the theory of reasoned action. The study collected data from 366 students who had taken one of the two programs completed 4 surveys: a demographic survey, the Sexual Risk Behavioral Belief and Self-Efficacy scale, the Sexual Abstinence scale, and the Effectiveness of Sexual Education scale. Students who completed the abstinence-plus program had higher levels of abstinent sexual attitudes, abstinent social norms, abstinent self-efficacy, and sexual decision-making self-efficacy when compared to students who completed the abstinence-only program, with a small effect size for abstinent social norms. Sexual abstinence behavior scores did not differ by program and programs and genders did not interact. Future studies should include a pretest and posttest evaluation. Analyzing these programs facilitates social change by informing the design of effective programs that focus on at-risk youth sexual behaviors.