Trauma exposure, acculturation stress, and tobacco, alcohol, cannabis, and amphetamine-type stimulant use among Syrian-origin adolescents under temporary protection in Türkiye: a 12-month longitudinal mediation analysis.

Background

Adolescence is a critical window for substance-use initiation, and early initiation predicts later substance-use disorders, school disengagement, and long-term harm. Displaced adolescents accumulate trauma and post-migration adversity during this window, yet host-country longitudinal evidence remains limited. Türkiye hosts one of the largest Syrian populations under temporary protection.

Objectives

We examined trauma exposure, acculturation stress, and 12-month substance-use trajectories among Syrian-origin adolescents under temporary protection in Türkiye, testing acculturation stress as a statistical mediator.

Methods

In a prospective cohort study, 250 Syrian-origin adolescents aged 12-18 years (52% male) and 150 matched non-Syrian Turkish adolescents were assessed at baseline and 12 months using the Childhood Trauma Questionnaire (CTQ) and an ARSMA-II-based acculturation-stress measure. Past-month tobacco, alcohol, cannabis, and amphetamine-type stimulant use were analyzed with generalized estimating equations, logistic regression, and counterfactual mediation.

Results

Syrian-origin adolescents had higher baseline past-month use than controls (tobacco 32% vs 15%; aOR = 2.4, 95% CI 1.6-3.7; other aORs 1.9-4.2). Group-by-time interactions showed greater increases for tobacco, cannabis, and amphetamine-type stimulants (ORs 1.12-1.25, all p < .05); alcohol was nonsignificant. Use concentrated among 16-18-year-olds. Each 1-SD baseline CTQ increase raised odds of any past-month use at follow-up (total effect OR = 2.69, 95% CI 2.13-3.40); the direct effect was OR = 2.04 (95% CI 1.61-2.58), and acculturation stress mediated 28% (indirect OR = 1.32, 95% CI 1.18-1.49).

Conclusion

Substance use among displaced Syrian-origin adolescents was elevated, persistent, and age-concentrated. Pediatric and school health services can embed brief, bilingual, trauma-informed screening into routine visits and link identified adolescents - particularly those aged 16-18 years - to confidential, low-threshold referral pathways.