The Co-Occurrence of Conduct Problems and Depressive Symptoms From Childhood to Adulthood for Men: Stability Over Time and Prediction to Substance Use.

The dual pathway hypothesis of risk for substance use was tested by examining risk from symptoms of conduct problems and depressive symptoms in adolescence (from ages 10-11 to 17-18 years) to substance use-including tobacco, alcohol, cannabis, and other illicit drugs-in both early adulthood (approximately from ages 20 to 29 years) and middle adulthood (approximately from ages 29 to 38 years). Hypotheses were tested on a sample of boys who were at risk for conduct problems by virtue of the neighborhoods where they lived in childhood (the Oregon Youth Study; N = 206 at Wave 1). Dual-trajectory modeling (Latent Class Analysis) resulted in a 3-group solution of high, moderate, and low co-occurring symptoms. The latent class of boys with co-occurring symptoms in adolescence showed higher levels of substance use in adulthood; namely, higher levels of cannabis and illicit substance use during early adulthood compared to either of the moderate or low symptom classes, and higher use of cannabis in midadulthood than the low symptom class. Those with co-occurring symptoms also showed, overall, higher vulnerability to use of tobacco in these 2 periods, but not to higher use of alcohol. Regression analyses indicated that the higher substance use of the co-occur group of men was related to their adolescent conduct problems, but was not related to their adolescent depressive symptoms; however, these associations were nonsignificant when adolescent use of the respective substances were included in the models. Thus, the dual-trajectory hypothesis was not supported. However, the findings indicated that, as assessed in the present study, the psychopathology symptoms of boys with conduct problems in adolescence who show risk for later substance use may be complex, involving depressive symptoms.

Recreational Cannabis Legalization and Proximity to Cannabis Retailers as Risk Factors for Adolescents' Cannabis Use.

Within-person studies are lacking regarding how recreational cannabis legalization (RCL) and the numbers of neighborhood cannabis retailers relate to adolescents' cannabis use. Study participants were 146 offspring (55% girls; 77% White non-Latinx) of men recruited in childhood from neighborhoods with high delinquency rates. Youth were assessed for past-year cannabis and alcohol use one or more times from ages 13 to 20 years (age M[SD] = 16.4 [2.1] years across 422 observations), while they were living in Oregon or Washington from 2005 to 2019 (where cannabis retail stores opened to adults ages 21 years and older in 2014 and 2015, respectively). We calculated distances between addresses of licensed cannabis retailers and participants' homes. Multilevel models that accounted for effects of age on cannabis use did not support that the number of retail stores within 2-, 5-, 10-, or 20-mile radii of adolescents' homes increased likelihood of past-year cannabis use at the within- or between-subjects levels. Likewise, primary models did not support a greater likelihood of cannabis use among youth whose adolescence coincided more fully with the post-RCL period. A secondary model suggested that after adjusting for adolescents' concurrent alcohol use as a marker of general substance use risk, RCL was associated with cannabis use (between-subjects B [95% CI] = .35 [.05-.66], p = .024). Further research is needed with larger prospective samples, at-risk subgroups, and as cannabis markets mature.

Ratings of executive function as a risk factor for adolescents' frequent cannabis use: A prospective longitudinal study.

OBJECTIVE: We examined the extent to which behavioral ratings of children's executive function (EF) in early adolescence predicted adolescents' cannabis use, and whether associations were independent of parents' cannabis and alcohol use and adolescents' alcohol use. METHOD: Participants were 198 offspring (44% boys) of 127 mothers and 106 fathers. Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF) at ages 11-14 years. Youth were interviewed repeatedly from ages 14 to 20 years regarding frequency of cannabis and alcohol use. Two-level models regressed dichotomous cannabis outcomes (annual, weekly, or daily use) on age at the within-person level and the random intercept of cannabis use on EF, parent substance use, and covariates (age 7 IQ indicators, child gender, parent education, and mean of ages assessed) at the between-person level. RESULTS: Poorer child EF predicted significantly (p < .05) higher likelihood of weekly (b[SE] = .64[.24]) and daily (b[SE] = .65[.25]), but not annual (b[SE] = .38[.22]), cannabis use. Parent cannabis use (b[SE] = .53[.25] to .81[.39], p < .05) independently predicted all three outcomes, and effects were distinct from those explained by parent alcohol use (b[SE] = .66[.29] to .81[.35], p < .05). EF remained a significant predictor of weekly and daily cannabis use after adjusting for parental alcohol and cannabis use, and adolescents' alcohol use. CONCLUSIONS: Children exhibiting poorer EF were more likely to use cannabis weekly and daily in later adolescence. Whereas literature suggests poorer EF may be a consequence of cannabis use, these findings suggest EF should be considered prior to cannabis use initiation. EF during childhood may be a fruitful prevention target. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations of Cannabis Use across Adolescence and Early Adulthood With Health and Psychosocial Adjustment in Early Adulthood and Midadulthood in Men.

Background: Associations between men's prior cannabis use and their physical and psychosocial adjustment were examined using prospective data across adolescence (ages 13-20 years), early adulthood (ages 20-30 years), and midadulthood (ages 30-38 years). The theoretical framework was based in developmental-contextual and lifespan approaches. Method: Models were tested using men in the Oregon Youth Study who had been studied since ages 9 to 10 years and who, in childhood, lived in neighborhoods with higher than average rates of delinquency. Cannabis use in adolescence was used to predict early adult outcomes (and early adult use to midadult outcomes). In addition, a set of covariates was added to the models, including childhood risk factors assessed at age 9 years (ie, family socioeconomic status; externalizing behaviors; and if available, the childhood proxy for the outcome [eg, age 9 intelligence scale]) and alcohol use in adolescence (or early adulthood). physical health outcomes included accidental injuries, problems resulting from a prior injury, body mass index, self-report health, and also pain and cardiovascular risk (blood pressure and pulse rate) in midadulthood. Psychosocial outcomes included income, housing insecurity, intelligence, depressive symptoms, psychosis symptoms, hostility/aggression, social problems, and attention problems. Results: Whereas there was almost no prediction from prior cannabis use to the physical health outcomes, there were comprehensive associations of cannabis use from the prior developmental period and psychosocial outcomes in both early adulthood and midadulthood. Conclusion: Cannabis use in prior developmental periods was associated with a broad range of types of poor psychosocial adjustment in adulthood.

Hospital-Based Healthcare Worker Perceptions of Personal Risk Related to COVID-19: One Year Follow-Up.

BACKGROUND: The COVID-19 pandemic has significantly impacted health care workers (HCW). Most research focused on the adverse mental health effects during the initial surge of cases; and yet little is known about approximately how workers are faring 1 year into the pandemic. The objective of this study is to examine stress, burnout, and risk perception in an academic medical system, 1 year after the start of the pandemic. METHODS: HCW across care specialties participated in online surveys in Spring 2020 and Spring 2021. The surveys included questions related to workplace stress and risk perception related to COVID-19. Correlates of stress and burnout were explored using multivariable linear regression models. Professional Quality of Life Scale (PROQOL) questions were added to the second survey. RESULTS: While HCW reported significantly fewer concerns about the risk of COVID-19 transmission to themselves and their families during the 2021 survey (compared with 2020), the percentage of workers who reported feeling excess stress at work or considered resigning stayed the same. One year into the pandemic, 57% of study participants met criteria for moderate or high levels of traumatic stress and 75% met criteria for moderate or high levels of burnout. As compared with participants who cared for no COVID-19 deaths, participants who cared for COVID-19 patients who died had significantly higher traumatic stress (1 to 10: Coef. = 2.7, P = .007; >10: Coef. = 6.7, P < .001) and burnout scores (1 to 10: Coef. = 2.7, P = .004; >10: Coef. = 2.6, P = .036). CONCLUSION: While Although perceptions of risk declined over the course of the year, levels of stress still remained high despite high vaccination rates. Those who witnessed more COVID-19 deaths were more likely to report increased burnout and post-traumatic stress. As our nation continues to grapple with the COVID-19 pandemic and new variants emerge it is imperative to focus on recovery strategies for high burnout groups to ensure the wellbeing of our health care workforce.

Intergenerational Associations in Crime for an At-Risk Sample of US Men: Factors that May Mitigate or Exacerbate Transmission.

Purpose: To examine moderation of intergenerational transmission of crime and antisocial behavior of parents to adult arrests of sons (from age 18 years to ages 37-38 years). Moderators examined were from late childhood (constructive parenting and sons' inhibitory control, internalizing symptoms, and cognitive function), adolescence (delinquency and deviant peer association), and early adulthood (educational achievement, employment history, substance use, deviant peer association, and partner antisocial behavior). Methods: Study participants were parents and sons (N = 206) from the longitudinal Oregon Youth Study, recruited from schools in the higher crime areas of a medium-sized metropolitan region in the Pacific Northwest. Assessment included official arrest records, school data, interviews, and questionnaires. Results: As hypothesized, parents' and sons' histories of two or more arrests were significantly associated. Predictions of sons' arrests from a broader construct of parental antisocial behavior were significantly moderated by sons' late childhood cognitive function and early adult employment history, substance use, and romantic partner's antisocial behavior. Overall, there was relatively little intergenerational association in crime at low levels of these moderators. Conclusions: Findings indicate relatively large intergenerational associations in crime. The identified moderators may be used as selection criteria or targeted in prevention and treatment efforts aimed at reducing such associations.

Associations of exposure to intimate partner violence and parent-to-child aggression with child competence and psychopathology symptoms in two generations.

BACKGROUND: Associations of exposure to intimate partner violence (IPV) and parent-to-child aggression (PCA) with child adjustment have not been examined adequately for community samples. OBJECTIVE: To examine main, cumulative, and interactive associations of IPV and PCA (separately for physical and psychological aggression) with four aspects of child adjustment (i.e., externalizing and internalizing behavior; social and scholastic competence). Associations were examined between (a) G1 parent behavior and the adjustment of G2 boys (N = 203) at ages 13-14 years and (b) G2 parent behavior and the adjustment of G3 children (N = 294) at ages 4-5 and 11-12 years. PARTICIPANTS AND SETTING: Families in a prospective, multigenerational dataset. METHODS: Measures included reports by caregivers, children, and teachers. Cross-sectional regression models (controlling for parent socioeconomic status and G3 child gender) examined: (a) main effects of IPV or PCA, (b) the simultaneous (i.e., cumulative) effects of both IPV and PCA, and (c) interactive effects of IPV and PCA (sample size permitting) on each of the child adjustment outcomes. RESULTS: When considered simultaneously, PCA (but not IPV) was associated with each aspect of child adjustment. The interaction between PCA and IPV indicated lower G2 adolescent scholastic competence and greater G3 preschool externalizing behavior for children exposed to lower levels of IPV and higher levels of PCA. CONCLUSION: Psychological and physical PCA were associated with child adjustment problems even when accounting for IPV. Findings support the use of evidence-based programs to prevent PCA and PCA-associated child adjustment problems.

Intergenerational congruence in adolescent onset of alcohol, tobacco, and marijuana use.

We examined alcohol, tobacco, and marijuana (ATM) use onset across early to late adolescence in a sample of fathers and their offspring. We tested a theory of developmental congruence in polysubstance use, or the extent to which fathers' ATM use onset in early adolescence increased risk for earlier ATM onset by their offspring. Average rates of adolescent ATM use onset were also compared across generations, which may reflect intergenerational discontinuity and secular trends. Children (n = 223, 44% boys) and their fathers (n = 113; originally recruited as boys at neighborhood risk for delinquency) contributed repeated prospective self-reports of their ATM use across adolescence (as late as age 18 years). Mothers' ATM use (retrospective) through age 18 years was available for 205 children. Data were analyzed using discrete-time survival mixture analysis. Compared with their fathers, boys and girls showed later onset for tobacco use, and girls showed later onset alcohol use. Developmental congruence was partially supported: Children showed earlier ATM use onset if their fathers were assigned to the early adolescent polysubstance use onset class, compared to the late-adolescent predominantly alcohol and tobacco onset class; mothers' ATM use in adolescence attenuated this effect. Consistent with national secular trends, rates of adolescent onset tobacco and alcohol use declined across generations, whereas marijuana use onset did not. However, there was intergenerational transmission of risk for early polysubstance use onset. Prevention that delays early substance use may have early life span effects as well as transgenerational implications. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Paternal and maternal prescription opioid use and misuse: General and specific risks for early adolescents' substance use.

BACKGROUND: Parent substance use is a risk factor early adolescents' substance use. Theoretical models of deviance and general substance use risk may not apply to risk-transmission pathways involving parents' prescription opioid misuse (POM) and child outcomes. Thus, we examined predictions of children's alcohol, tobacco, and marijuana (ATM) use in early adolescence, from parental POM, delinquency, depressive symptoms, and ATM use. METHOD: Children (n = 216; 121 female) participated from early childhood to ages 11-12 or 13-14 years with their 111 fathers and 136 mothers. At all available waves, self-reports were collected on each parents' POM, ATM, prescription opioid use (POU), depressive symptoms, and delinquent behavior, and children's ATM use. RESULTS: Poisson regressions were run separately by parent, controlled for child age and gender and paternal age at child's birth, and accounted for clustering of children in families. Child ATM use was predicted by paternal POM, but the effect was better explained by paternal ATM use, which was a stronger effect in families with higher father-child residential contact. In contrast and unexpectedly, mothers' POU but not POM predicted child ATM use, and the effect was not explained by the significant predictions from maternal ATM use and delinquency. CONCLUSION: Fathers' POM and mothers' POU predicted child ATM use by early adolescence. Findings generally were consistent with parent-child risk-transmission processes described for other substances. Resident fathers' substance use and multiple maternal risk factors are worthy foci for prevention of the intergenerational transmission of substance use.

Men's misuse of prescription opioids from early to middle adulthood: An examination of developmental and concurrent prediction models.

OBJECTIVE: The prevalence of misuse of prescription opioids across adulthood and the associations of such misuse with symptoms of psychopathology and use of other substances were examined for an at-risk community sample of men. METHOD: For a longitudinal study of boys (N = 206) followed to adulthood, misuse of prescription opioids was assessed on 13 occasions from ages 20-21 years to 37-38 years. Prediction of misuse was examined from prospectively assessed risk factors in 3 models: (a) parental substance use during the men's adolescence; (b) the men's own risk behaviors in adolescence-delinquent behavior, depressive symptoms, and use of tobacco, alcohol, marijuana, and opioids; and (c) within- and between-individual effects of the men's risk behaviors during adulthood. RESULTS: Opioid misuse was reported by 29% of men. After accounting for effects of age and considered individually, parent marijuana use and all of the adolescent and adult risk factors (except adolescent depressive symptoms) were significant between-individual predictors of opioid misuse. Furthermore, within-individual prediction was significant for adult delinquency and alcohol use after accounting for increases in opioid misuse with age. When risk factors were tested simultaneously, men's adult delinquency and use of marijuana and tobacco remained significant between-individual predictors, whereas no parental or adolescent risk factors remained significant in these models. CONCLUSION: Both adolescent and adult risk factors were examined that predicted adult opioid misuse. Preventing adolescent problem behavior and using such histories to inform screening for misuse risk in adulthood may reduce the burden of the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intergenerational associations in physical maltreatment: Examination of mediation by delinquency and substance use, and moderated mediation by anger.

Findings as to whether individuals' experiences of physical maltreatment from their parents in childhood predict their own perpetration of physical maltreatment toward their children in adulthood are mixed. Whether the maltreatment experienced is severe versus moderate or mild may relate to the strength of intergenerational associations. Furthermore, understanding of the roles of possible mediators (intervening mechanisms linking these behaviors) and moderators of the intervening mechanisms (factors associated with stronger or weaker mediated associations) is still relatively limited. These issues were examined in the present study. Mediating mechanisms based on a social learning model included antisocial behavior as assessed by criminal behaviors and substance use (alcohol and drug use), and the extent to which parental angry temperament moderated any indirect effects of antisocial behavior was also examined. To address these issues, data were used from Generations 2 and 3 of a prospective three-generational study, which is an extension of the Oregon Youth Study. Findings indicated modest intergenerational associations for severe physical maltreatment. There was a significant association of maltreatment history, particularly severe maltreatment with mothers' and fathers' delinquency. However, neither delinquency nor substance use showed significant mediational effects, and parental anger as a moderator of mediation did not reach significance.

Peer teasing experiences of fathers and their children: Intergenerational associations and transmission mechanisms.

Being the victim or perpetrator of peer teasing threatens children's immediate and long-term well-being. Given that many individual and contextual risk factors for peer victimization are transmitted within families, we tested whether fathers' childhood victimization experiences were directly or indirectly (via poor parenting and poor child adjustment) associated with their children's increased risk for similar experiences. Generation two (G2) fathers (n = 130) who had been assessed since age 9 years participated in an intergenerational study with their 268 G3 children and the 163 G2 mothers of these children. Peer teasing ratings were collected annually from G1 mothers, fathers, and teachers across G2 ages 9-16 years, and from the same three informant types across the same ages for G3 children. Also assessed was G2 fathers' poor parenting of G3 at ages 3-7 years and G3 poor adjustment (externalizing and internalizing behaviors, deviant peer association, low social competence) and body mass index (BMI) at ages 7-16 years. Models supported intergenerational stability in being teased that was partially mediated through G2 fathers' poor parenting and G3 poor adjustment. A direct intergenerational path in being teased remained significant, and G3 BMI uniquely predicted being teased. Childhood peer victimization is perpetuated across generations. Prevention aimed at poor parenting, child poor adjustment, and peer victimization itself may disrupt intergenerational stability in these adverse experiences.

Intergenerational Associations in Sexual Onset: Mediating Influences of Parental and Peer Sexual Teasing and Youth Substance Use.

PURPOSE: The prospective intergenerational association between fathers' age of onset of sexual intercourse and their son's or daughter's age of onset of oral sex or intercourse up to 30 years later was examined using survival analyses across child ages 11-12 years to 17-18 years. In addition, novel constructs of parental and peer sexual teasing (at ages 11-12 years) and general risk factors of child substance use onset (alcohol and marijuana) before or concurrent with sexual onset were assessed as predictors of children's sexual onset and mediators of intergenerational associations. METHODS: Hypotheses were tested using the Oregon Youth Study Intergenerational sample, including 100 fathers and 176 children (46% girls). RESULTS: Univariate findings indicated that children were at risk for earlier sexual onset, provided their fathers had onset of sex at younger ages; in addition, child alcohol and marijuana onset and parental, but not peer, sexual teasing predicted earlier age of sexual onset for children. Multivariate findings indicated that child alcohol onset fully mediated the intergenerational association in age of sexual onset, whereas parental teasing and child marijuana onset did not explain the intergenerational association. CONCLUSIONS: Findings of intergenerational associations in risk of sexual onset indicate that mechanisms of this association should be further examined. Substance use onset also confers risk for earlier child sexual onset, with alcohol use onset accounting for intergenerational associations; thus, substance use onset should be a prime target for prevention. Parental sexual teasing warrants further study as a mechanism related to possibly unintended encouragement of youth's early sexual onset.

Parenting and the development of effortful control from early childhood to early adolescence: A transactional developmental model.

Poor effortful control is a key temperamental factor underlying behavioral problems. The bidirectional association of child effortful control with both positive parenting and negative discipline was examined from ages approximately 3 to 13-14 years, involving five time points, and using data from parents and children in the Oregon Youth Study-Three Generational Study (N = 318 children from 150 families). Based on a dynamic developmental systems approach, it was hypothesized that there would be concurrent associations between parenting and child effortful control and bidirectional effects across time from each aspect of parenting to effortful control and from effortful control to each aspect of parenting. It was also hypothesized that associations would be more robust in early childhood, from ages 3 to 7 years, and would diminish as indicated by significantly weaker effects at the older ages, 11-12 to 13-14 years. Longitudinal feedback or mediated effects were also tested. The findings supported (a) stability in each construct over multiple developmental periods; (b) concurrent associations, which were significantly weaker at the older ages;

Proximal vs. distal predictors of alcohol use disorders and treatment utilization in at-risk men in early middle age.

Understanding factors that predict both development and treatment of alcohol misuse and its consequences can inform prevention and treatment efforts. This study used measures of both proximal (e.g., behaviors) and distal (e.g., traits) risk factors that were predicted to relate to both an alcohol use disorder (AUD) and to treatment utilization among AUD-diagnosed men to test the hypothesis that both type of factors predict AUDs but only proximal factors influence treatment-seeking. Analyses of variance with contrasts were used to compare the means for risk factors between men with an AUD and AUD-free men and-given an AUD diagnosis-between men who were treated for an AUD and untreated men (n=181). As predicted, men with AUDs differed on a broad range of proximal and distal factors, including number of alcohol problems, alcohol-related influences of peers and partners, alcohol expectancies, familial factors, and psychopathology. As hypothesized, only proximal risk factors predicted treatment-seeking among the AUD men, particularly alcohol problems and related consequences.

Growth in externalizing and internalizing problems in childhood: a prospective study of psychopathology across three generations.

Three generations of participants were assessed over approximately 27 years, and intergenerational prediction models of growth in the third generation's (G3) externalizing and internalizing problems across ages 3-9 years were examined. The sample included 103 fathers and mothers (G2), at least 1 parent (G1) for all of the G2 fathers (99 mothers, 72 fathers), and 185 G3 offspring (83 boys, 102 girls) of G2, with prospective data available on the G2 fathers beginning at age 9 years. Behavior of the G2 mother, along with father contact and mother age at birth were included in the models. Intergenerational associations in psychopathology were modest, and much of the transmission occurred via contextual risk within the family of procreation.

Intergenerational influences on early alcohol use: independence from the problem behavior pathway.

Conduct problems are a general risk factor for adolescent alcohol use. However, their role in relation to alcohol-specific risk pathways of intergenerational transmission of alcohol use is not well understood. Further, the roles of alcohol-specific contextual influences on children's early alcohol use have been little examined. In a 20-year prospective, multimethod study of 83 fathers and their 125 children, we considered the predictors of child alcohol use by age 13 years. The predictors included fathers' adolescent antisocial behavior and alcohol use, both parents' adult alcohol use, norms about and encouragement of child use, parental monitoring, child-reported exposure to intoxicated adults, and parent-reported child externalizing behaviors. Path models supported an association between fathers' adolescent alcohol use and children's use (ß = 0.17) that was not better explained by concurrent indicators of fathers' and children's general problem behavior. Fathers' and mothers' adult alcohol use uniquely predicted child use, and exposure to intoxicated adults partially mediated the latter path. Other family risk mechanisms were not supported. However, parental alcohol use and child alcohol use were linked in expected ways with family contextual conditions known to set the stage for alcohol use problems later in adolescence.

Stability of intimate partner violence by men across 12 years in young adulthood: effects of relationship transitions.

The present study examined the stability of young men's intimate partner violence (IPV) over a 12-year period as a function of relationship continuity or discontinuity. Multiwave measures of IPV (physical and psychological aggression) were obtained from 184 men at risk for delinquency and their women partners. The effects of relationship continuity versus transitions on change in IPV were examined using multilevel analyses. In general, men's IPV decreased over time. Men's physical aggression in their early 20s predicted levels of physical aggression about 7 years later, and men's psychological aggression in their early 20s predicted levels of psychological aggression about 10-12 years later. As hypothesized, higher stability in IPV was found for men who stayed with the same partners, whereas men experiencing relationship transitions showed greater change. The IPV of new partners was linked to the changes in men's IPV that occurred with repartnering. There was less change in men's IPV over time as men changed partners less frequently.

Changes in At-Risk American Men's Crime and Substance Use Trajectories Following Fatherhood.

Fatherhood can be a turning point in development and in men's crime and substance use trajectories. At-risk boys (N = 206) were assessed annually from ages 12 to 31 years. Crime, arrest, and tobacco, alcohol, and marijuana use trajectories were examined. Marriage was associated with lower levels of crime and less frequent substance use. Following the birth of a first biological child, men's crime trajectories showed slope decreases, and tobacco and alcohol use trajectories showed level decreases. The older men were when they became fathers, the greater the level decreases were in crime and alcohol use and the less the slope decreases were in tobacco and marijuana use. Patterns are consistent with theories of social control and social timetables.

The timing of smoking onset, prolonged abstinence and relapse in men: a prospective study from ages 18 to 32 years.

AIM: To describe the rate and timing of smoking onset, prolonged abstinence (≥1 year) and relapses from ages 18 to 32 years in initially smoking and non-smoking men. DESIGN: A 23-year longitudinal study. SETTING: Untreated community sample. PARTICIPANTS: A total of 154 American boys were recruited at age 10 years to a larger study (n=206) of delinquency risk; 71 participants who smoked cigarettes and did not use smokeless tobacco and 83 participants who initially did not use tobacco were followed from age 18 to 32 years. MEASUREMENTS: Frequency of tobacco use and weekly cigarettes smoked in the past year were assessed annually. Onset (>6 cigarettes/week), abstinence (0 tobacco uses in the past year) and relapse (>0 cigarettes/week) were tracked annually. FINDINGS: Of smokers, 36% achieved 1 or more years of abstinence by age 32 years; 52% who reached abstinence relapsed at least once. One-half of men who showed onset after age 18 years were smoking at the end of the study, compared to nearly three-quarters of men who were smokers at age 18 years. Risk for relapse following prolonged abstinence was strongest initially and diminished thereafter. Transition probabilities were stronger for the second period of abstinence than for the first. Models were limited by sample size and statistical power. CONCLUSIONS: Relapses continue to erode men's quit success even after long periods of abstinence from smoking. Long-term abstinence, despite intervening relapse, bodes well for eventual abstinence. Adolescent onset appears relevant to the likelihood of adult abstinence and relapse patterns.