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.

Akaltun &. · The American journal of drug and alcohol abuse · 2026

**Background & Methods** This prospective cohort study examined 250 Syrian-origin adolescents aged 12-18 years under temporary protection in Türkiye and 150 matched non-Syrian Turkish controls, assessed at baseline and 12 months. Trauma exposure was measured using the Childhood Trauma Questionnaire (CTQ), acculturation stress via an ARSMA-II-based measure, and past-month substance use (tobacco, alcohol, cannabis, amphetamine-type stimulants) analyzed through generalized estimating equations, logistic regression, and counterfactual mediation analysis. **Key Findings** • Syrian-origin adolescents demonstrated significantly higher baseline past-month substance use compared to Turkish controls across multiple substances: tobacco (32% vs 15%; aOR=2.4, 95% CI 1.6-3.7), with other substances showing aORs ranging 1.9-4.2. • Over 12 months, Syrian-origin adolescents showed greater increases in tobacco, cannabis, and amphetamine-type stimulant use (ORs 1.12-1.25, p<0.05), with use concentrated among 16-18-year-olds; alcohol use changes were nonsignificant. • Trauma exposure demonstrated a significant dose-response relationship with substance use: each 1-SD increase in baseline CTQ scores raised odds of any past-month use at follow-up (total effect OR=2.69, 95% CI 2.13-3.40). Acculturation stress mediated 28% of this effect (indirect OR=1.32, 95% CI 1.18-1.49), with a direct effect of OR=2.04 (95% CI 1.61-2.58). **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This longitudinal cohort study provides moderate-quality evidence with several limitations: reliance on self-reported substance use without biological verification, lack of randomization inherent to observational design, potential unmeasured confounding variables, and generalizability constraints to Syrian refugee populations in Türkiye. Strengths include prospective design, validated trauma and acculturation measures, and formal mediation analysis. The authors recommend embedding trauma-informed, bilingual substance-use screening into routine pediatric and school health services with referral pathways for high-risk adolescents aged 16-18 years.

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