Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants

  • Erin L. Woodhead
  • Brenda M. Booth
  • Christine Timko
  • Amanda Tjemsland
  • Xiaotong Han
  • Michael A. Cucciare


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.


Older adults Rural health Stimulant use Health care utilization Health outcomes 



This research was supported by the National Institute on Drug Abuse (R01 DA15363 to Brenda M Booth, and R01 DA14340 to Harvey A Siegel, and then to Robert Carlson). Dr. Timko was supported by VA HSR&D (RCS 00-001).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

Study approval was obtained from the Institutional Review Boards at the investigators’ institutions. All participants provided informed consent. A certificate of confidentiality was obtained from the National Institute on Drug Abuse.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Erin L. Woodhead
    • 1
  • Brenda M. Booth
    • 2
  • Christine Timko
    • 3
    • 4
  • Amanda Tjemsland
    • 3
  • Xiaotong Han
    • 2
    • 5
    • 6
  • Michael A. Cucciare
    • 5
    • 6
    • 7
  1. 1.Department of PsychologySan José State UniversitySan JoseUSA
  2. 2.Division of Health Services Research, Psychiatric Research InstituteUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Center for Innovation to ImplementationVeterans Affairs (VA) Health Care SystemMenlo ParkUSA
  4. 4.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  5. 5.Center for Mental Healthcare and Outcomes ResearchCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  6. 6.VA South Central (VISN 16) Mental Illness Research, Education, and Clinical CenterCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  7. 7.Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockUSA

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