Prevalence of stimulant use among adolescents and young adults by pseudo-cohort and sex: evidence from a national survey

Background: In the United States, youths and young adults face rising prescription stimulant exposure, particularly among females, and an ongoing overdose epidemic involving stimulants.Objective: To evaluate time trends in prescription stimulant misuse and nonprescription stimulant use among youths and young adults by age, pseudo-cohort, and sex. Evaluating sex-specific trends may inform targeted prevention strategies.Methods: We constructed nationally representative age-by-survey-year pseudo-cohorts (i.e., incremented cross-sectional groups approximating longitudinal cohorts) beginning at age 12 using public-use data from the National Survey on Drug Use and Health (NSDUH), 2002–2019 and 2021–2023. Outcomes included past-year prescription stimulant misuse and nonprescription stimulant use, analyzed by age, sex (50.7% male), and pseudo-cohort.Results: Prescription stimulant misuse was higher among females than males in mid-adolescence across pseudo-cohorts (e.g. a 2.3% point difference, p < .001, among 15-year-olds in the 2002 pseudo-cohort; a 2.1% point difference, p = .027, among 16-year-olds in the 2010 pseudo-cohort). Both stimulant outcomes were higher among males in early adulthood in the 2002 pseudo-cohort (e.g. a 4.4% point difference for nonprescription stimulants, p < .001, among 19-year-olds), but this gap closed over time. More recently, males and females had similar levels of stimulant misuse/use in early adulthood (e.g. nonprescription stimulants, p = .305 for 19-year-olds).Conclusions: Adolescent prescription stimulant misuse has increased among females. Sex differences in nonprescription stimulant use during early adulthood have diminished. Increasing stimulant prescribing among females, along with limited awareness of misuse potential, may contribute to these trends. These findings support prevention strategies that account for sex-specific patterns of stimulant misuse and nonprescription stimulant use.