Background: Despite overall declines in risky teen sexual activity, racial and ethnic disparities persist. This study compared abstinence-only and comprehensive teen pregnancy prevention (TPP) programs to explore the effects of the programs on teen sexual activity-related outcomes that may differ by race/ethnicity. Methods: Program evaluation data were collected from 7th-grade students in comprehensive (N = 3244) and abstinence-only (N = 3172) TPP programs. Differences between outcomes by TPP program were analyzed using chi-square tests and logistic regression for each racial/ethnic group. Results: Black and Hispanic students were significantly less likely to indicate positive attitudes, intentions, and behaviors at baseline. Only white students significantly improved in both programs from pre- to post-assessment. Native American students in the abstinence-only program were significantly less likely than Native American students in the comprehensive sexuality programming to improve from pre- to post-assessment regarding male sexuality, refusal skills, sex and teen norms, and sexual abstinence. Conclusions: The findings suggest that youth of diverse racial/ethnic backgrounds do not enter TPP programs with similar attitudes, intentions, or behavior regarding appropriate sexual behavior and that the impact of such programs also may vary by race and ethnicity.