Identifying demographic and psychosocial factors related to the escalation of smoking behavior among Mexican American adolescents

•Over the course of 5 years, 29% of the adolescents escalated in smoking behavior.•Higher levels of anxiety were associated with escalation in smoking.•Intentions to smoke and having friends that smoke increased the risk of escalation.•Higher levels of subjective social status were protective against escalation.•Parents' friends influence was stronger than household influence on escalation.

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health.N = 1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age = 11.8 (SD = 0.8), and 26.0% were born in Mexico.By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR = 1.30; CI = 1.07-1.57), male (OR = 1.88, CI = 1.40-2.53), having higher levels of anxiety (OR = 1.03, CI = 1.02-1.05), intending to smoke (OR = 1.70, CI = 1.18-2.46), having friends who smoke (OR = 1.73, CI = 1.12-2.70) and having parents' friends who smoke (OR = 1.38, CI = 1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR = 0.91, CI = 0.83-0.99) were protective against smoking escalation.Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation.