Background: Rates of homicides by adolescents under age 18 years tripled from 1984 to 1994. Most studies report data on urban adolescents and young adults as a single age group (age 15-24 years), but homicide characteristics among adolescents, especially those younger than 15 years, may differ from those of young adults. Objective: To describe the homicide characteristics among adolescents age 11 to 18 years in North Carolina from 1990 to 1995. Methods: A retrospective, descriptive analysis of adolescent homicides using the medical examiner database. Police interviews provided additional information for cases from 1993 to 1995. Results: There were 419 victims from 1990 to 1995 (average annual rate: 9.7 per 100 000 adolescents; 9.9 in urban counties, 7.1 in rural). Victims were mostly ages 15 to 18 years (85%), male (79%), and black (76%); 48% lagged behind in school, and, by police report, 40% had a criminal record. Only 23% of the identified perpetrators were strangers. Firearms (59% were handguns) were used in 83% of homicides. Proportionally more younger adolescents (age 11-14 years) were killed by means other than firearms than 15- to 18-year-olds (χ2=24.2, P =. 007). Drug-related motives (23%) were most common, followed by non-drug-related altercations (20%) and retaliations (17%). Conclusions: Proportionally more North Carolina adolescents than urban young adults (ages 15-24 years) were killed by firearms (83% vs 75%). Proportionally fewer adolescents were killed by police, strangers, or intimate partners. Interventions should include reducing access to firearms and drugs, and helping adolescents develop nonviolent strategies to resolve disputes. Efforts should be focused on adolescents who lag behind in school and have criminal records.