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Background This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife. Methods Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 4 were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18-3. Latent classes were then used as predictors of physical health problems, c