The scale of the findings is difficult to overstate. Adverse childhood experiences, commonly abbreviated as ACEs, are potentially traumatic events that occur before the age of 18, ranging from abuse and neglect to household dysfunction and community-level violence. Decades of research, beginning with the landmark 1998 Felitti and Anda investigation in the United States, have established that ACEs are not isolated misfortunes but tend to co-occur, and that their cumulative burden produces dose-dependent increases in disease risk, mental illness, and early mortality. The new Turkish data extend this epidemiological logic to a population of emerging adults navigating the transition to university life, a developmental window in which health behaviors often crystallize into lifelong patterns.

The study relied on a web-based cross-sectional survey administered between April and June 2024. Participants completed a structured self-report questionnaire assessing exposure to ACEs, including child maltreatment and household dysfunction, alongside a battery of health-risk behaviors in young adulthood. Web-based surveys of this kind allow rapid recruitment across a dispersed student population, though the authors acknowledge that self-report instruments inherently depend on participants’ willingness and ability to recall sensitive childhood events. Ethical approval was granted by the Ethics Committee of Giresun University, and informed consent was obtained from all participants in accordance with the Declaration of Helsinki.

What the questionnaire revealed is a hierarchy of adversity that few observers would have predicted at the top. The most frequently reported ACE was community violence, experienced by 81.1 percent of respondents, a striking figure that suggests violence exposure beyond the household is the dominant adversity shaping this cohort. Emotional neglect followed at 74.0 percent, then emotional abuse at 49.9 percent, witnessing violence against household members at 39.2 percent, bullying at 33.2 percent, and physical abuse at 27.9 percent. The prominence of emotional neglect and emotional abuse, forms of maltreatment that leave no bruises yet corrode a child’s sense of worth and security, underscores the argument of trauma researchers that psychological adversity can be as consequential as physical harm.

The analytical heart of the study lies in the association between cumulative ACE scores and adult health-risk behaviors. The researchers found that a higher number of ACEs was significantly linked to tobacco use, alcohol consumption, sedentary behavior, overweight and obesity, suicidal ideation, suicide attempts, interpersonal violence, and early sexual initiation, defined as sexual activity before the age of 16. This constellation of outcomes is consistent with the well-documented dose-response relationship observed internationally, from studies of college students in Zambia, Vietnam, Uganda, and Brazil to systematic reviews such as the 2017 Hughes and Bellis meta-analysis in The Lancet Public Health, which concluded that individuals with four or more ACEs face substantially elevated risks across mental and physical health domains.

Several mechanistic frameworks help explain why childhood adversity casts such a long shadow. The toxic stress model proposes that chronic activation of the hypothalamic-pituitary-adrenal axis during sensitive developmental periods alters stress regulation, immune function, and neural circuitry in ways that persist into adulthood. Behavioral theories add that health-risk behaviors often serve as coping strategies, with nicotine, alcohol, and other forms of self-regulation providing short-term relief from emotional pain that originated in childhood. Social learning perspectives further note that children raised in violent or neglectful environments may internalize interpersonal violence as normative, a pathway that could help account for the observed association between ACE burden and subsequent involvement in interpersonal violence.

The near-universal prevalence of at least one ACE in this sample, 97.7 percent, is notably higher than in many comparable studies and invites careful interpretation. Broader ACE inventories that include community violence and bullying, as this one does, inevitably capture more of the population than the original ten-category frameworks focused narrowly on household dysfunction. Still, the finding that nearly half the sample carried four or more ACEs signals a substantial public health burden within Turkish higher education, one that likely reflects the cumulative effect of economic precarity, exposure to regional conflict and earthquake trauma, and gaps in child protection infrastructure. Prior Turkish research, including a 2016 comparison of parent and child reports of maltreatment published in the Central European Journal of Public Health, has suggested that official figures substantially undercount the true prevalence of child maltreatment in the country.

The suicide-related findings deserve particular emphasis. Both suicidal ideation and suicide attempts were significantly associated with higher ACE counts, echoing results from Ugandan university students and American college populations. Young adulthood is already a peak period for the onset of suicidal behavior, and the intersection of unprocessed childhood trauma with the academic, financial, and social pressures of university life appears to create a particularly volatile combination. University counseling services, the authors’ findings suggest, should routinely screen for childhood adversity rather than treating presenting symptoms in isolation, because the developmental roots of distress may lie far beneath the surface.

Çam and Ustuner Top conclude that their results highlight the need for trauma-informed public health strategies aimed at preventing ACEs and promoting resilience. Trauma-informed care, in this framework, means redesigning educational, health, and social systems to recognize the prevalence of trauma, avoid re-traumatization, and build protective factors such as stable adult relationships and community support. The authors received no external funding for the work and declared no competing interests. Because the data are sensitive, they are not openly available but can be requested from the corresponding author for reasonable research purposes.

Limitations remain, as they do in all cross-sectional self-report research. Temporal ordering between ACEs and adult behaviors cannot be definitively established, recall bias may shape reported adversity, and a web-based convenience sample of university students may not generalize to young adults who never enter higher education, a group often at even greater risk. Yet the convergence of this Turkish dataset with findings from across five continents suggests a robust biological and social reality: the wounds of childhood do not stay in childhood. Every percentage point of ACE prevalence that public health systems can reduce, researchers argue, translates downstream into fewer cancers, addictions, suicide attempts, and violent injuries, making early prevention one of the highest-leverage interventions available to any society.

Subject of Research: Adverse childhood experiences and their association with health-risk behaviors among Turkish university students

Article Title: Adverse Childhood Experiences and Associated Health-Risk Behaviors Among University Students in Turkey: A Cross-Sectional Analysis

Article References: Adverse Childhood Experiences and Associated Health-Risk Behaviors Among University Students in Turkey: A Cross-Sectional Analysis. (n.d.). https://doi.org/10.1007/s40653-026-00979-z

Image Credits: AI Generated

DOI: 10.1007/s40653-026-00979-z

Keywords: adverse childhood experiences, ACEs, university students, Turkey, health-risk behaviors, child maltreatment, emotional neglect, community violence, suicidal ideation, trauma-informed care, public health, cross-sectional study