We compared baseline smokeless tobacco users who demonstrated harm escalation (I,e, became a dual user or switched to cigarettes) with the reference group of exclusive smokeless tobacco users. Risk-taking was a significant predictor for harm escalation. Smokeless tobacco users who agreed that illegal risk-taking was fun were move likely to escalate harm through smoking initiation (OR=5.19 ; 95% CI=1.05, 25.60 ;p=.04).