Objective: To describe and understand variations in social influences on smoking behavior among African-American and white male and female adolescents in Baltimore City, USA.
Design: A qualitative study where adolescents, both smokers and non-smokers, were interviewed individually (n = 21) and participated in focus groups (n = 18 focus groups, 3-10 participants per group).
Results: Social contexts emerged as most relevant and salient themes related to smoking behavior. White females perceived the most permissive parental messages around smoking, while males, especially African-American males, reported receiving the strictest parental sanctions. Females' need to fit in with peers contrasted with males' being coerced to smoke. Possible reasons for African-Americans' non-use of cigarettes include a desire not to disrespect parents and being turned off by parental addiction to nicotine. All adolescents cited the school's lax anti-smoking policy as a reason teens smoke at school.
Conclusion: Interventions targeted at schools and families offer promise for reducing adolescent cigarette use.