Risky behavior and depression are linked to energy drink and tobacco use among Palestinian refugee children in a conflict setting: A cross-sectional study

Palestinian refugee children are prone to using energy drinks (EDs) and smoking tobacco because of their stressful lives. Limited research has focused specifically on Palestinian adolescents in the context of depression and substance use. This study aims to examine the effects of ED intake and tobacco smoking on the mental health of refugee children on the West Bank. A cross-sectional study was conducted in 2022 among 362 Palestinian refugee schoolchildren (aged 12-15) in 5 camps on the northern West Bank. Data on ED and tobacco use were collected through structured interviews. Depression was assessed via the Birleson Depression Self-Rating Scale for Children, psychosomatic symptoms were self-reported for the most recent 1-month period, and waist circumference was measured. χ2 tests, Fisher exact test, and logistic regression analyses were performed to examine associations between substance use, depression, and obesity. Among the 329 participants, 53.8% reported using ED, 22.8% smoked waterpipe (WP), and 11.6% smoked cigarettes. Depression was noted in 28.9% of children. Logistic regression revealed that depression was more prevalent among girls (OR = 2.7, 95% confidence interval (CI):1.57-4.98, P-value < .001) and was associated with cigarette smoking (OR = 2.6, 95% CI: 1.15-5.98, P-value = .022) and ED intake (OR = 1.808, 95% CI: 1.04-3.17, P-value = .038). No associations between WP use and electronic cigarette use were detected. The study revealed that depression and risky behaviors were highly prevalent among Palestinian refugee children. ED and tobacco use were strongly associated with depressive symptoms and psychosomatic complaints. These findings highlight the urgent need for early detection, culturally tailored school-based interventions, and mental health support programs for refugee adolescents. Future research should explore longitudinal effects and preventive strategies to reduce substance use and improve child mental health in conflict settings.