Smoking initiation and progression to regular smoking in African American young adults: A qualitative study of facilitators and intervention points

Background: African Americans start smoking later than whites and Hispanics, are less likely to quit smoking, and make fewer quit attempts. This study examined attitudes, beliefs, and environmental influences on smoking initiation and regular smoking in African American (AA) young adults. Methods: Twelve 2-hour focus groups (n=99) were conducted with AA young adults 18-29 years old. Results: Participants did not start smoking earlier because of strong anti-smoking messages from their mother and grandmother. Participants expected a strong message from older family members to stop smoking but were told they were an adult at 18. Left on their own to make the decision, young adults saw no reason to quit. Participants felt being old enough to purchase cigarettes at 18 made it acceptable. AA young adults experienced increased stress from life transitions and first turned to smoking to cope. Smoking was often the only coping mechanism participants used. Smoking was also seen as a substitute for smoking marijuana or extending the marijuana high. AA young adult professionals hid their smoking from others. Smoking was viewed as unprofessional behavior. Young adults did not smoke around respected elders and often hid their smoking from them. Young adults did not smoke at church. Women often stopped smoking during pregnancy but started back after the baby was born.ž Conclusions: Focus groups identified points where public health interventions could decrease initiation and promote cessation in AA young adults, including building on respect for elders, continuing strong anti-smoking messages throughout adulthood, and teaching teens healthier coping strategies.