A systematic review of the factors influencing the risky behaviors of syrian forced migrant children and adolescents in Turkey

Risky behaviors are defined as emotional and behavioral problems that harm mental and physical health. The present study aimed to systematically review and synthesize research investigating the risky behaviors of Syrian children living in Turkey. The study was conducted through a systematic review of articles published in the Scopus and Web of Science database between 2013 and the present day, and met the STROBE reporting criteria. The inclusion criteria for studies in the systematic review were established, and studies that focused on Syrian-origin forced migrant child-adolescents aged 7–18 years and investigated risky behaviors without a clinical diagnosis and treatment purpose were included. Four studies with a sample of 790 children were examined. According to the findings of this study, there is a measurement issue for risky behaviors. In this study, there are numerous factors influencing risky behaviors, including those related to traumatic life events due to war, psychopathology, acculturation-related factors, and sociodemographic factors. The most significant finding highlighted in the study is the need for methodological improvements and context-specific studies to be repeated in future research, to ensure statistical generalizability and clinical implications in research on this subject. Plain Language Summary Studies on the factors influencing risky behaviors in children and adolescent forced migrants have been conducted using diverse research designs, questions, hypotheses, and results. Risky behaviors are defined as emotional and behavioral problems that harm mental and physical health. The present study aimed to systematically review and synthesize research investigating the risky behaviors of Syrian children living in Turkey. According to the findings of this study, there is a measurement issue for risky behaviors. In this study, there are numerous factors influencing risky behaviors, including those related to traumatic life events due to war, psychopathology, acculturation-related factors, and sociodemographic factors.


Introduction
Young forced migrants confront significant pre-and post-migration period difficulties.These difficulties are losing a family member in armed conflict, separation from loved ones, being unaccompanied, experiencing or witnessing torture, and facing social exclusion, poverty, discrimination, and acculturative stress after migrating to a new country.The pre-and post-migration challenges are well documented in the literature, but they do not encompass all the difficulties faced by forced child-adolescent migrants (Bennouna, et al., 2020).A meta-analysis conducted by Fazel et al. (2012) which included 5,776 forced migrant children, found that exposure to violence in a newly migrated community poses a significant risk to their mental health.Furthermore, Lustig et al. (2004) systematic review suggests that challenges during migration should also be considered as risk factors for mental health in forced migrant children.Additionally, research by Reijneveld et al. (2005) conducted with unaccompanied forced migrant adolescents detained in state facilities in the Netherlands, found that socially restrictive facility rules negatively affected their mental health.Therefore, it is crucial to consider the diverse range of challenges faced by forced migrant children and provide them with appropriate support and resources to promote their mental health and wellbeing.In his research, Hollins (2007) posited that the lack of social support networks, inability to communicate with parents effectively, and the adverse effects of age all contribute to the poor mental health of unaccompanied forced migrant adolescents.Although studies in the literature can serve as reference points for identifying factors that negatively affect the mental health of forced migrant children and adolescents, no universally agreed-upon generalizable factors exist.However, risky behaviors emerge as psychological and social problems that result from or can lead to psychological disorders following the aforementioned life challenges (Geltman et al., 2005;Halcón et al., 2004;Hirani et al., 2018;Horyniak et al., 2016;Loughry & Flouri, 2001).Different conceptualizations of risky behaviors exist in the literature.Bronstein and Montgomery (2011), as well as Gormez et al. (2018) defined risky behaviors as emotional and behavioral problems that are also signs of psychopathology.Other researchers define risky behaviors as emotional and behavioral problems that harm mental and physical health, including risky sexual behaviors, substance use, and reckless driving (Owens et al., 2020).Risky behaviors in this study are defined as emotional and behavioral problems that harm mental and physical health.Emotional problems involve internally suppressing negative emotions without externalizing them, leading to social withdrawal, somatic problems, anxiety, depressive symptoms, suicidal thoughts and suicide attempts.In contrast, behavioral problems involve directing negative emotions outward towards others (e.g., conduct problems such as delinquent behaviors, hyperactivity/inattention, senseation seeking) or having problematic relationships with others (peer problems) (Gormez et al., 2018).Studies on the factors influencing risky behaviors in children and adolescent forced migrants have been conducted using diverse research designs, questions, hypotheses, and results.These studies highlight the importance of understanding that the factors influencing risky behaviors cannot be generalized and are context specific.Vasic et al. (2021) emphasized that untreated mental health problems, stressful living conditions, and insufficient social support can increase the risk of alcohol and substance use among children and adolescent forced migrants.Similarly, Koumantakis et al. (2022) highlighted that ethnic differences are significant risk factors for alcohol and substance use among forced children and adolescents.Although not specifically focused on forced migrant children and adolescents, Martinez et al. (2018) conducted another study that identified a positive relationship between forced migration and risky behavior, even though it was carried out on adult forced migrants.A study conducted by Martinez et al. (2018) on 1,383 Mexican male migrants who applied for asylum and were forcibly detained in state facilities until their applications were processed found that acculturative stress affected risky sexual behaviors in this group.According to Martinez et al. (2018), logistic regression analysis was used to examine the relationships between acculturave stress, risky sexual behavior, and HIV testing history.The study found that acculturative stress increased the likelihood of engaging in risky sexual behavior.However, the literature indicates that the relationship between acculturative stress and risky behaviors is not exclusive to forced migrant groups.A study conducted by Lorenzo et al. (2017) on 5384 adolescent migrants found that intergenerational differences significantly increased risky behaviors.According to Lorenzo et al. (2017), the results of logistic regression indicated that migrant boys, particularly those from the first and second generations, were less likely to engage in alcohol misuse than natives.However, despite exhibiting similar tendencies to migrants, boys of mixed origins were found to be more prone to risk behaviors at the bivariate level.In the case of girls, migrant adolescents from the first and second generations were less likely to engage in alcohol misuse but were three times more likely to be excessive internet users.Conversely, girls of mixed origins were more likely to have their parents living apart, and were more inclined to engage in antisocial behaviors.Conversely, research conducted by Ceri et al. (2017) on the effects of generational disparities on the emergence of emotional and behavioral issues in second-generation migrant teenagers showed that these differences increased the likelihood of such problems (e.g., depression, post-traumatic stress disorder, substance abuse, anxiety, and delinquent behavior).While the results of the studies by Lorenzo et al. (2017) and Ceri et al. (2017) may appear contradictory, they also reveal a shared aspect at a certain level.Generational disparities and ethnic differences in migrant children and adolescents are significant risk factors for the development of emotional and behavioral problems.In addition, according to the literature review by Chimienti et al. (2019), intergenerational differences in the migrant children-adolescent group, such as being a second-generation individual, are evaluated to make this group more prone to experiencing emotional and behavioral problems.According to Chimienti et al. (2019), to mitigate the risks posed by intergenerational differences, it is necessary to include this group in education under the guidance of multicultural education policies.On the other hand, based on a fully structured qualitative research conducted by Rizk et al. (2023) on a group of 52 Syrian forced migrant adolescents in Lebanon, this situation should not only be considered within the scope of migrant children-adolescent groups but should also be taken into account within the context of forced migrant children-adolescent groups who have migrated due to conflict, and policies and programs should be developed accordingly.It is important to note that research on the factors influencing risky behaviors in children and adolescent forced migrants is ongoing, and more research is needed to fully understand the complexities of this issue.Although there are numerous studies in the international literature that investigate the factors that influence risky behaviors in child-adolescent forced migrants, research conducted in Turkey on this topic is scarce.It is essential to explore this subject in Turkey because it is one of the countries with the highest number of forced migrants relative to its population, and Syrian individuals under temporary protection status constitute a significant portion of these migrant groups.According to data from the Turkish Ministry of Interior's Migration Directorate in September 2023, 1,611,265 Syrian children in Turkey are under temporary protection status and aged between 0 and 18 years.The aim of this study was to systematically review the limited research on the risky behaviors of children living in Turkey and synthesize the information obtained.The following research questions were formulated and the research process was initiated to answer them.
RQ1.Does the psychopathology of Syrian children and adolescents impact their engagement in risky behaviors?
RQ2.If Syrian children and adolescents in Turkey have experienced traumatic events related to the Syrian Civil War, is this a factor in their engagement in risky behaviors?
RQ3.How do the sociodemographic characteristics of Syrian children and adolescents in Turkey influence their likelihood of engaging in risky behaviors?

Material and method
To maintain transparency and impartiality, the author utilized the STROBE reporting criteria before conducting a systematic analysis of relevant studies.Furthermore, specific inclusion and exclusion criteria were established for this systematic review.The studies included in this research adhered to the STROBE reporting criteria and focused on Syrian children and adolescents of forced migrants aged 7-18 years in Turkey, investigating risky behaviors without considering clinical diagnosis and treatment.In this study, the STROBE statement, adapted to Turkish by Babaoglu et al. and considering cultural differences, was employed (Babaoglu et al., 2021).In this study, the inclusion and exclusion criteria used STROBE criteria are provided in Table 1.Simultaneously, the STROBE criteria in this study also represent the scientific quality of the included studies in this research.
In this study, abstracts of articles obtained through filtering were initially read.Subsequently, if these articles were published within the last 5 years, if they included quantitative methods, and if the abstract of the study indicated that the target group of the research was Syrian children and adolescents in Turkey, the obtained studies were examined according to the STROBE criteria mentioned above (Babaoglu et al., 2021).

Search strategy
The publication dates of the articles in the Scopus and Web of Science database ranged from 2013 to September 2023.The rationale for selecting 2013 as the starting point was to mark the commencement of the Syrian Civil War and the initial migration of Syrians to Turkey.The reason for selecting only these databases in this study is the relatively higher scientific quality (reliability, validity, scientific reporting, data transparency) of journal articles indexed in these two databases compared to journal articles indexed in databases such as Google Scholar, PsycInfo and PubMed.
The following keywords, abstracts, and article titles were used in the search: Syrian, child, children, minor, minors, adolescents, adolescent, adolescence, youth, mental health, problem, problems, risk, risks, sexual, Turkey, and Türkiye.After obtaining the search results, filtering was performed.The preferences for filtering included document type as articles; subject area as medicine, psychology, social sciences; keywords such as refugees, Syria, adolescent, child, Turkey, mental health, child, Syrian, publication status as published; and the country where the study was conducted as only Turkey.The inclusion criteria for the study were as follows: the research must have been conducted with a participant group of Syrian children and adolescents of forced migrants aged 7-18 years in Turkey, the research must have been conducted with high-quality scientific reporting, meeting the STROBE reporting criteria, and the research must have been conducted without clinical diagnosis and treatment purposes.The exclusion criteria were as follows: studies published more than 5 years ago, studies that did not meet the STROBE reporting criteria, and studies that did not fulfill any of the inclusion criteria.Provide unadjusted and, if applicable, confounder-adjusted estimates along with their accuracy levels (e.g., 95% confidence intervals).
Clearly specify which confounders were adjusted for and the rationale behind their inclusion

Results
Twenty-nine articles were retrieved based on the research strategy outlined in this study, a total of 29 articles were retrieved.These articles were published between 2014 and the present, and have received a cumulative 654 citations according to the Scopus database.However, no research related to the topic could be found in the journals indexed in Web of Science using the specified keywords.Therefore, no filtering has been applied in Web of Science.
We excluded studies that did not meet our inclusion criteria (Figure 1).Four studies were included in our analysis based on the STROBE criteria.The details of the included studies, which have received a total of 32 citations, are presented in Table 2.The participants in these studies ranged in age from seven to 18 years, with a total of 790 participants.
In addition to the results mentioned above, a total of five studies were excluded because they were published five years ago or more.Because the five studies share a common characteristic in that they were published five or more years ago, they were grouped together under a single criterion in Figure 1.The results of these studies are shown in Table 3.These articles were published between 2014 and 2018 and received 339 citations according to the Scopus database.Sapmaz et al., 2017 conducted an examination of the factors affecting the risky behavior of Syrian, Iraqi, Iranian, and Afghan children living in Turkey who had been exposed to war-related migration through structured clinical interviews.The research revealed that children who had witnessed dead or wounded individuals during the war, as well as children with unemployed fathers, exhibited increased levels of risky behavior.ORs were 7.077 (95% CI = 1.722-29.087)for having seen a dead or injured individual and 4.51 (95% CI = 1.668-12.199)for father's employment status.However, this study also has significant methodological limitations, as researchers did not evaluate the forced migrant children and adolescents in the aforementioned ethnic groups within their own ethnic groups.Instead, the analysis was based on the evaluation of these ethnic groups as a whole.This approach raises concerns regarding the study's scientific validity and reliability, as it is not representative of the diverse experiences and behaviors of the specific ethnic groups in question.Previous studies have demonstrated the importance of considering ethnicity when examining risky behaviors.According to Koumantakis et al. (2022) Compared with natives, students from Non-Western/Non-European countries (nW) showed a lower risk of risky behaviors (e.g., smoking habit, delinquent behaviors) (OR: 0.72, 95%CI = 0.58-0.89)and weekly alcohol consumption (OR:0.57,95%CI = 0.43-0.75).Given the limited number of studies investigating the risky behaviors of Syrian child-adolescent forced migrants in Turkey and the factors that prevent these behaviors, it is essential to discuss and further investigate these findings.

Risky behaviors: Primary findings of included studies
In the studies included in this review (n = 4, sample size = 790), risky behaviors were reported as emotional and/or behavioral psychiatric problems.To assess these risky behaviors, the validated and reliable Turkish version of the SDQ scale was used in all studies (n = 4, sample size = 790) (32).The sub-factors of the scale, which measure these behavioral problems, include behavioral, emotional, peer relationship, and social behavior problems.A score above the cutoff point for each sub-factor indicates a psychological problem in that factor, whereas a score above the total cutoff score is interpreted as a symptom of psychopathology in the individual.Table 4 presents the findings related to factors that significantly influence risky behaviors (p < .05) in the included research.
According to Duren and Yalçın (2021) mediation model, the mediating role of war related traumatic life experience scores on the relationship between social trust and risky behaviors was examined.Study findings showed that The social trust score demonstrated a positive and significant relation to risky behaviors (B = À.26, p < .01).In addition, social trust was a significant predictor of war-related traumatic life experience scores (B = À51, p < .01),and the direct effect of social trust on risky behaviors was not significant when war-related traumatic life event scores were included in the model (B = À.19 p > .05).The indirect effect of social trust on risky behaviors through war-related traumatic life event scores was significant (CI = À0.1434,À0.0270).Finally, the findings suggest that war-related traumatic life event scores fully mediated the relationship between social trust and   (B = 0.981 p < .003).In addition, Karadag and Ogutlu (2021) study findings there is a inversely association between parents' educational attaintment and risky behaviors.(for mother's years of schooling r = À0.327p < .0.01 and for father's years of schooling r = À0.252p < .05).They also found noted that Syrian child-adolescent forced migrants have difficulty forming relationships with their Turkish peers and experience higher emotional, behavioral, and psychiatric problems, even though there is no statistically significant difference in sociodemographic variables (p > .05).Eruyar et al. (2020) examined the influence of fortifying and jeopardizing the mental health of Syrian child-adolescent.According to Eruyar et al. (2020), findings insecure attachment (for mother perceived insecure attachment r = .139p < .01 for father perceived insecure attachment r = .201p < .01)and parental attitudes (for perceived over-protective parenting r = .168p < .05for perceived rejectful parenting r = .266p < .01)positive association to the development of risky behaviors and other mental health issues in this population.

Second findings of included studies
The ages of the children participating in the study ranged from 7 to 18 years (Duren & Yalçın, 2021;Eruyar et al., 2020;Karadag and Ogutlu, 2021;Çeri & Nasiroglu, 2018).In addition, Eruyar et al. (2020) found that Syrian children who participated in the study were born in Syria and sought refuge in Turkey during the war.Furthermore, the study conducted by Çeri and Nasiroglu (2018) was carried out with Syrian children who sought refuge in Turkey and continued their education there.Similarly, the participants in the study by Duren and Yalçın (2021) were also children and adolescents who sought refuge from Syria to Turkey.In the study by Karadag and Ogutlu (2021) while there is no specific information on this matter, all Syrian-origin children and adolescents who participated in the research mentioned that they had been subjected to or witnessed torture or violence during the war.Considering this information, Karadag and Ogutlu's (2021) participant group of Syrian origin also sought refuge from Syria to Turkey.Based on the observations made regarding the participant groups, it was determined that all had experienced traumatic life events resulting from the war.Furthermore, as reported in previous studies, the participant groups were identified as first-generation forced migrants.All studies were carried out with Syrian-origin children and adolescents attending school in Turkey (Duren & Yalçın, 2021;Eruyar et al., 2020;Karadag and Ogutlu, 2021;Çeri & Nasiroglu, 2018).Two of the studies, Karadag and Ogutlu, and Çeri and Nasıroglu conducted an analysis to measure the impact of parental education status on the risky behaviors of children.
The results of Karadag and Ogutlu (2021) study, analysis showed that an increase in parental education level was inversely correlated with risky behaviors in children (for mother's years of schooling r = À0.327p < .0.01 and for father's years of schooling r = À0.252p < .05).Additionally, in Çeri and Nasıroglu study findings showed that having a father with a low education level was found to increase children's risky behavior scores (B = 1.151 p < .009).Other findings besides these, Çeri and Nasiroglu (2018) included a question regarding this in their study to measure the effect of the acculturative factor on risky behaviors.According Çeri and Nasiroglu (2018) the question of dissatisfaction with settling in Turkey was asked and was found to have a positive association with risky behaviors (B = 0.981 p < .003)These factors, which have been demonstrated in the literature to have an effect on the mental health and risky behaviors of children and adolescents, were addressed in some of the studies reviewed.However, some of these factors were not queried in all the studies, which creates a deficiency in comprehending and explaining the risky behaviors of child-adolescent forced migrants of Syrian origin in Turkey.

Discussion
The aim of this study was to systematically review the limited research on the risky behaviors of children living in Turkey and synthesize the findings obtained.The following research questions were formulated and the research process was initiated to answer them.At the end of the study, answers have been found to the research questions.In all the studies included and examined in this study, risky behaviors have been utilized as indicators of mental health problems and/or psychopathological symptoms (Duren & Yalçın, 2021;Eruyar et al., 2020;Karadag and Ogutlu, 2021;Çeri & Nasiroglu, 2018).Specifically, these behaviors have been linked with psychiatric symptoms in several of the aforementioned studies (Duren & Yalçın, 2021) and explored in relation to the differences between war-related traumatic life events and psychiatric symptoms.Moreover, these studies have demonstrated that sociodemographic characteristics and acculturative factors can also influence risky behaviors (Çeri & Nasiroglu, 2018).While most studies have tended to assume that risky behaviors arise as a result of psychopathology or as a consequence of existing psychopathology, defining them as mental health problems, Eruyar et al. (2020) study have shown that risky behaviors and post-traumatic stress disorder are not associated with war-related traumatic life events but with attachment relationships established with parents during childhood and perceived parenting attitudes.They demonstrated that secure attachment and positive parenting attitudes have a preventive effect on these factors.However, the literature on this subject, most studies on child-adolescent forced migrants examine risky behaviors by linking them to individual psychopathology, suggesting that these behaviors result from psychopathology and also impact the continuation of psychopathologies (Bronstein & Montgomery, 2011;Geltman et al., 2000Geltman et al., , 2005;;Gormez et al., 2018;Lustig et al., 2004).

Lack of research examining the risky behaviors of syrian child-Adolescent forced migrants in Turkey
The limited number of studies on this subject is closely linked to the cultural concept of 'guest' in Turkish society.In societies that uphold traditional values, such as Turkey, the concept of 'guest' encompasses certain rules of etiquette and decency for both the host and the guest.When examining the relationship between this concept and the subject matter, it is observed that during the early years of the Syrian civil war; the Turkish government made statements about the Syrians who had sought refuge in Turkey, characterizing them as guests and emphasizing that they would return once the conflict had ended.As a result of this actions, the perception of Syrians as 'guests' began to take hold in Turkish society.(NTV, 2012;Hurriyet, 2014;Erdogan, 2014).According to Erdogan (2019), Turkish society still holds the belief that Syrians will eventually return, and this belief has been instrumental in shaping Turkish society attitudes towards Syrians.Koçak's (2021) study, which focuses on this topic and yields noteworthy results, reveals that the awareness of religious and national belonging in Turkish society has a positive impact on attitudes towards Syrians.
The aforementioned research findings are closely intertwined with the notion of hospitality in Turkish society towards Syrians.In particular, the cultural and religious values of the Turkish society are incorporated within the guest concept.Consequently, the scarcity of studies exploring the risky behaviors of Syrian forced migrant children and adolescents in Turkey, as highlighted in the research, can be perceived as a cultural prejudice that Syrians, as guests, are not supposed to exhibit such behaviors.It is therefore recommended that further research be conducted in this topic.

Characteristics of research conducted in Turkey compared to international literature
In this study, the research conducted in Turkey closely aligns with international literature.The study by Eruyar et al. was the only exception. Görmez et al. (2018) study, conducted with Syrian children and adolescents in Istanbul, found that traumatic life events related to war and various psychiatric disorders were associated with risky behaviors.Geltman et al. 's (2000Geltman et al. 's ( ), (2005) ) research supports these findings.Other studies have also demonstrated the negative impact of parental attitudes and socioeconomic status on the risky behaviors of child and adolescent forced migrants (Belhadj et al., 2014).Bronstein and Montgomery's (2011) systematic study indicates that emotional and behavioral problems as well as sociodemographic factors such as age, gender, and the country of migration are related.Research by Lustig and colleagues (2004) shows that war-related traumatic life events impact stress, coping strategies, and risky behaviors among child and adolescent forced migrants.
Differences in research conducted in Turkey on the topic when compared to international literature The studies included in this systematic review revealed discrepancies with respect to the international literature on the topic.Specifically, the research inquired into the age of Syrian child-and adolescent-forced migrants, but no study found that age had a significant impact on risky behaviors.However, Sourander (1998) reported an association between older age and increased psychiatric problem scores, which included risky behaviors among child and adolescent forced migrants who applied for asylum in Finland and were kept in shelter centers until their applications were processed.Similarly, Reijneveld and colleagues (2005) found that strict rules in shelter centers for child and adolescent forced migrants in the Netherlands who applied for asylum had a positive effect on their risky behaviors.These two studies share the common characteristic of involving child-and adolescent-forced migrants residing in shelter centers with strict rules.In the context of the systematic review, this finding can be attributed to acculturative factors, as the studies conducted in the Turkish context did not involve forced child and adolescent migrants residing in shelter centers with strict rules.In all the research conducted in Turkey and examined in this study, it was found that all the participants attended school.While there are studies suggesting that education and educational achievement contribute to the psychosocial well-being of refugee-origin individuals living in Europe (Chimienti et al., 2019), other studies have shown that not being able to participate in education has an impact on various psychiatric problems in forced child-adolescent migrants (Bennouna et al., 2020;Blackmore et al., 2020).However, in Lebanon, it was found that attending school did not have a preventive effect on risky behaviors among Syrian children and adolescent forced migrants, but perceived social support was identified as a preventive factor influencing these behaviors (Kheirallah et al., 2020).Additionally, longitudinal research on adolescents in the United States has shown that school belongingness has a preventive effect on risky behaviors (Resnick et al., 1997).Studies have also examined the relationship between school and risky behaviors from different perspectives, such as the factors that contribute to psychological resilience, one of which is school and academic achievement (Werner, 2013).It is widely acknowledged in the literature that simply attending school is not sufficient to promote psychological resilience in adolescents and that additional educational programs conducted within schools can enhance their resilience (Bester & Kuyper, 2020).Consequently, there are studies in the literature that both support and refute the idea that school-and school-related factors have a preventive effect on risky behaviors among forced child and adolescent migrants.However, none of the studies examined in this research investigated the impact of school-related factors on risky behaviors despite the fact that all participants attended school.Therefore, future research should explore the influence of school-related factors on the prevalence of risky behaviors among this population.
Research on the risky behaviors of syrian child-adolescent forced migrants in Turkey has identified certain gaps in the existing literature and methodology (Frounfelker et al., 2020) highlighted the importance of familial and community-based risks in shaping the risky behaviors of this population.Among these risk factors, living in single-parent families, residing with parents who have psychiatric problems, facing economic hardship, experiencing discrimination, and exposure to violence or witnessing violence in the host country are particularly noteworthy.While Karadag and Ogutlu's (2021) study touched upon the presence of parents with psychiatric illnesses in the families of child adolescents, no other study has examined these factors.Moreover, studies that have investigated the risky behaviors of migrant children, such as Vollebergh et al.'s (2005) research in the Netherlands, have primarily focused on socioeconomic status as a risk factor.Beiser et al. (2002) also explored generational differences among migrants.However, Harker's (2001) research has demonstrated the significance of generational differences in shaping the mental health of migrant adolescents.Lorenzo and colleagues ( 2017) have also highlighted the potential impact of intergenerational differences on risky behaviors in childadolescents.Despite the relevance of these factors, none of the studies included in this research investigated them.In light of these findings, it is recommended that future research on Syrian childadolescent forced migrants in Turkey should consider the impact of familial and community-based risks, as well as generational and cultural differences, on their risky behaviors.

Factors preventing risky behaviors in child-adolescent forced migrants in international literature
Various studies have investigated the factors that prevent risky behaviors and contribute to the psychosocial well-being of forced migrant child-adolescents.In the study conducted by Kheirallah et al. (2020) with Syrian children-adolescents attending school in Jordan, it was found that warrelated traumatic history has a significant relationship with smoking in forced migrant Syrian childadolescents; However, it was determined that perceived family and friend social support had a preventive effect on this relationship.In other words, traumatic life events are associated with the behavior of smoking; However, social support from family and friends has a preventive effect on this relationship.Bennouna et al. (2020) state that the main factors that prevent risky behaviors in child-adolescent forced migrants are access to education, establishing relationships with the new community, feeling safe, and feeling social belonging.According to the systematic review study conducted by Belhadj et al. (2014), it has been argued that the migration experience is not a significant determinant of mental health and risky behaviors in child and adolescent forced migrants.Furthermore, the study found that living conditions, access to education, and family functionality have a preventive effect on risky behaviors and positively impact psychosocial well-being in this population.In contrast, according to Prilleltensky (2008), the factors that determine the risky behavior and psychological health of forced migrants are psychological preparation for forced migration, physical health, friendship relations, and language knowledge.In addition, Prilleltensky (2008) argues that displaying good parenting skills in the family, mutual support within the family, and having a good level of mental health also have a preventive effect on risky behaviors.In addition, Chimienti et al. (2019) stated that participation in the education of children and adolescents from refugee families contributes to the integration and psychosocial well-being of this group.In summary the impact and importance of access to education, family functionality, language knowledge, peer relations, socioeconomic levels, social support, war-related traumatic migration experience, and social exclusion on the psychosocial well-being and risky behaviors of child-adolescent forced migrants should be taken into consideration.It is recommended to conduct research on these factors mentioned in this study from a holistic perspective.

Limitations
In the field of refugee law, several legal statuses exist, including refugees, asylum seekers, temporary protection, and secondary protection.In this research, all of these statuses have been collectively classified as "forced migrants."This categorical approach is problematic because it fails to recognize the distinct rights and obligations associated with each status.To address this issue, this study employs a human-centered perspective of "forced migrant."This approach serves as a conceptual boundary for this study.
Additionally, the legal framework of the Republic of Turkey defines childhood as ending at the age of 18.As such, this study focuses on individuals who have not yet reached their 18th birthday.This age restriction represents another conceptual limitation of this study.
In Turkey, the age for a child to start school is 7. Since the aim of this study was to systematically examine the results of research conducted on forced migrant Syrian child-adolescents in Turkey, it was assumed that children under the age of 7 were illiterate; therefore, the inclusion criteria were determined as children between the ages of 7-18.

Conclusion and recommendations
It is apparent that multiple factors influence risky behaviors, including trauma-related events associated with war, psychopathology, acculturation, and socio-demographic factors.However, of the four studies included in this research, three analyzed these factors through intergroup differences, correlation, and regression analyses.This represents a methodological deficiency.Additionally, three of the four studies have qualitatively similar methodologies, literature, and research objectives, repeating each other and international literature.The most significant finding of the study is that for future research to be statistically generalizable and clinically applicable, there is a need for methodological improvement and replication of context-specific studies in research on this topic.

Table 1 .
STROBE Criteria Used for Inclusion and Exclusion in the Study.
the research design, inclusion criteria, exposure conditions, follow-up status, and data collection periods Participants 6 Cross-sectional study -explain the criteria for participant inclusion, the selection method, sources, and follow-up status Variables 7 Clearly define all outcomes, exposures, predictor variables, potential confounders, and effect modifier variables.Specify diagnostic criteria if applicable Data sources/ Measurement 8 For each relevant variable, specify the data sources and details of the assessment methods.If there are multiple groups, explain whether the methods are comparable Scientific bias/Sides 9 Describe efforts to address potential biases and sources of bias in the study Sample size 10 Explain how the sample size was determined Quantitative/Qualitative variables 11 Explain how quantitative/qualitative variables were addressed in the study.Clarify any groupings made, detailing how and why they were done if applicable Statistical methods 12 a) Cross-sectional studyif applicable, consider the sampling method and explain the statistical methods employed b) Explain how missing data were handled Participants 13 a) Specify the number of individuals at each stage of the studye.g., the potentially eligible, those assessed for eligibility, those confirmed eligible, those enrolled in the study, and those completed
identified psychiatric disorders and risky behaviors in Syrian child-adolescent forced migrants who have been in Turkey for seven years.The main risk factors contributing to risky behaviors in this study are parental maltreatment (B = 1.03 p < .05),fathers with low education levels (B = 1.151 p < .009),being female (B = 1.50 p < .007),and dissatisfaction with settling in Turkey

Table 3 .
Excluded Studies Publication Date More Than Five Years Criterion.

Table 4 .
Factors That Increase Risky Behavior.