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There is limited knowledge about age-related differences in health outcomes and treatment utilization among rural stimulant users. The current study examined physical health, mental health, and treatment utilization (hospital, mental health, and substance use care) among 710 stimulant users living in rural areas of the United States. Generalized estimating equations (GEE) were used to examine associations between age and physical health, mental health, and treatment utilization over a 3-year period. Analyses controlled for participants’ gender, race, and education. To capture age-related differences, participants were grouped into emerging adults (18–25 years old, n = 223), early-mid adults (26–44 years old; n = 384), and older adults (45–61 years old; n = 103). At baseline, older stimulant users were in significantly poorer health even though they had significantly fewer substance use problems than emerging adult users. GEE models indicated that substance use outcomes improved for all participants over the course of the study but other outcomes remained stable. Older stimulant users continued to have worse physical health and mental health, even though they had fewer substance use problems, than the other age groups. Older adults also used more hospital and mental health services than the other age groups. White participants tended to be at higher risk for negative outcomes than nonwhite participants. We conclude that rural older adults who use stimulants have poor health despite having milder substance use problems and using more health care resources, and need targeted intervention to improve health outcomes.


This is a post-peer-review, pre-copyedit version of an article published in the Journal of Adult Development. The final authenticated version is available online at: SJSU users: Use the following link to login and access the article via SJSU databases.

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