Numerous studies indicate the ineffectiveness of abstinence-only education in preventing teen pregnancies and the spread of sexually transmitted infections (STIs), yet many U.S. schools still rely on abstinence-only programming. North Dakota, the focus of this study, neither prevents nor requires contraception instruction in sexual health education classes, leaving the decision to include contraception instruction and other sexual health information up to the individual schools and teachers. For this study, a survey of sexual health teachers was used to determine the content of sexual health classes, teacher characteristics, and links between the two. Results indicate that teacher beliefs in program efficacy impact what content is included in class, which suggests the need to provide evidenced based training and continuing education for sexual health teachers.