{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:16:04Z","timestamp":1788171364150,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea"},{"id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Academic pressure during examination periods is frequently reported alongside irregular lifestyle behaviors. The study aimed to explore the interplay between habitual eating behaviors, sleep quality, and self-reported stimulant use and coping adaptations specifically during examination periods among healthcare university students. Methods: This cross-sectional study included 265 university students (Mage = 22.00, SD = 4.46). Dietary behaviors and sleep quality were assessed using the Three-Factor Eating Questionnaire (TFEQ-R21) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Behavioral profiles, substance-use patterns, and attitudes toward academic pressure were examined using bivariate analyses, multivariate logistic regression, and TwoStep cluster analysis. Statistical analyses were performed using IBM SPSS Statistics version 26.0. Results: A high prevalence of poor sleep quality was observed, with 72.8% (n = 193) of participants meeting the clinical criterion for poor sleep (PSQI &gt; 5.0; M = 7.79 \u00b1 3.53), and high sleep disturbances were significantly associated with smoking, energy drink use, coffee escalation, general dietary supplement utilization, and smart-drug use. Multivariate analysis revealed that poor sleep quality (OR = 1.118, 95% CI [1.022, 1.222]) and younger age (OR = 0.843, 95% CI [0.735, 0.967]) were independently associated with higher odds of energy drink use. A distinct cognitive disconnect was observed in tobacco usage: conventional smoking was negatively associated with self-perceived health (OR = 0.401, 95% CI [0.182, 0.884]), whereas electronic cigarette use showed no significant association. TwoStep cluster analysis identified three distinct student typologies during exams: non-users (32.6%), poly-substance users (34.5%), and OTC supplement\/caffeine users (33.0%), with active substance-utilizing profiles displaying significantly worse sleep quality and higher emotional eating. Conclusions: These findings highlight distinct cross-sectional lifestyle and coping patterns among healthcare students, emphasizing the need for targeted institutional interventions that support healthy behavioral adaptations and stress management during academic challenges.<\/jats:p>","DOI":"10.3390\/nu18172847","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"2847","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral Profiles of Exam Stress: Mapping Student Diet, Sleep, and Substance Use"],"prefix":"10.3390","volume":"18","author":[{"given":"Andreea-Sabina","family":"Butucaru","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Iustina-Gabriela","family":"Mih\u0103ianu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7074-959X","authenticated-orcid":false,"given":"Magdalena","family":"Iorga","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Faculty of Psychology and Educational Sciences, \u201cAlexandru Ioan Cuza\u201d University, 700554 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Lucian Roman","family":"\u0218ipo\u0219","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4555-1364","authenticated-orcid":false,"given":"Dan Alexandru","family":"Sl\u0103vescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2953-3842","authenticated-orcid":false,"given":"Raluca Ortensia Cristina","family":"Iurcov","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Alrashed, F.A., Alsubiheen, A.M., Alshammari, H., Mazi, S.I., Al-Saud, S.A., Alayoubi, S., Kachanathu, S.J., Albarrati, A., Aldaihan, M.M., and Ahmad, T. 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