Date of Award


Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA



To discuss rural-urban disparities of adolescent unplanned pregnancies and sexual education availability. The potential of virtual sexual education programs are discussed by examining two studies that have used technology-based interventions to assess variables related to pregnancy prevention.

Data Sources

A review was conducted by gathering randomized controlled trials and systematic reviews utilizing databases such as ScienceDirect, PubMed and Wiley Online Library. Research articles included in this paper were from 1995 to present day and are inclusive of all races.

Study Eligibility Criteria

Studies were included if the interventions worked with young adolescents ages 13-24 year old, utilized technology-based interventions for sexual education and were conducted in the United States.

Study Appraisal and Synthesis Methods

The first meta-analysis examined 16 studies that were experimental designs and measured condom use or abstinence as outcomes. The studies chosen were rated for quality and risk of bias using the Cochrane Collaboration’s tool of assessing risk of bias. The second source was a study that looked at two rural Appalachian high schools that were similar demographically and were statistically identical on all but one variable (refusal self-efficacy). The schools were randomly assigned to either the control or experimental group to participate in a seven week program. The surveys pre- and post-intervention evaluated condom negotiation self-efficacy, attitudes toward abstinence and situational self-efficacy.


The meta-analysis concluded that there was a small but significant effect on condom use and a significant effect on abstinence over time with technology-based interventions. The second study with the Appalachian high schools concluded that the experimental school had greater knowledge, greater condom negotiation self-efficacy, more favorable attitudes toward waiting to have sex and greater situational self-efficacy compared to the control school. There were no significant differences in regard to condom self-efficacy or refusal self-efficacy.


The higher rates of unplanned pregnancies in the rural areas of the United States can be associated with the lack of sexual education available. Technology-based programs hold the potential to close this gap based on several of the studies that have been conducted that have shown to have significant effect on variables of safer sex practices. Ultimately, more studies and research is needed to evaluate the short-term and long-term effects of virtual sexual education.