Background: Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighborhood-level violence and smoking behaviors in a cohort of Mexican smokers from 2011–2012, and whether neighborhood-level social cohesion modified these relationships.

Methods: Data were analyzed from adult smokers and recent ex-smokers who participated in Waves 5–6 of the International Tobacco Control Mexico Survey. Self-reported neighborhood violence and social cohesion were asked of Wave 6 survey participants (n=2129 current and former smokers, n=150 neighborhoods). Neighborhood-level averages for violence and social cohesion (range 4–14 and 10–25, respectively) were assigned to individuals. We used generalized estimating equations to determine associations between neighborhood indicators and individual-level smoking intensity, quit behaviors, and relapse.

Results: Higher neighborhood violence was associated with higher smoking intensity (Risk Ratio (RR)=1.17, 95% Confidence Interval (CI) 1.02–1.33), and fewer quit attempts (RR=0.72, 95% CI 0.61–0.85). Neighborhood violence was not associated with successful quitting or relapse. Higher neighborhood social cohesion was associated with more quit attempts and more successful quitting. Neighborhood social cohesion modified the association between neighborhood violence and smoking intensity: in neighborhoods with higher social cohesion, as violence increased, smoking intensity decreased and in neighborhoods with lower social cohesion, as violence increased, so did smoking intensity.

Conclusion: In the context of recent increased violence in Mexico, smokers living in neighborhoods with more violence may smoke more cigarettes per day and make fewer quit attempts than their counterparts in less violent neighborhoods. Neighborhood social cohesion may buffer the impact of violence on smoking intensity.