Changes in Anxiety Symptoms and Eating Patterns Among Emerging Adult Students in a Non-Traditional School Program During a Mathematics Examination

<b>Background/Objectives:</b> The semi-school-based model (SSBM) has gained momentum in Mexico post-COVID-19, providing flexibility for students managing work, family, and academics. However, little is known about how high-stakes academic evaluations affect the emotional well-being and lifestyle habits of students in this alternative setting. This study aims to assess two key research questions: (1) Does exposure to a high-stakes academic exam increase anxiety and depression levels in SSBM students? (2) Does exam-related stress affect dietary habits and physiological stress markers in these students? <b>Methods:</b> A prospective, longitudinal, quantitative study was conducted in September 2023 with 94 fourth-term high school students in an SSBM program in Mexico Assessments. Evaluations were conducted at two specific time points; Pre-exam Assessment Day (RCD): ~30-50 min before normal Saturday classes, and Exam-day Assessment (ED): ~30-50 min before the mathematics exam. Data included sociodemographic, HADS scores, dietary habits, and physiological measures (blood pressure, heart rate, oxygen saturation). Analyses were conducted in SPSS v28. Normality was tested using Kolmogorov-Smirnov. Paired continuous and categorical variables were compared with Wilcoxon signed-rank and McNemar's or Fisher's exact tests, respectively. Relative risks (RR) and multivariate logistic regression identified factors associated with anxiety and depression. Significance was set at <i>p</i> < 0.05. <b>Results:</b> Anxiety prevalence increased significantly on the exam day (from 22.3% to 59.6%, <i>p</i> < 0.001; RR = 14.281, 95% CI: 2.620-161.296), with no significant change in depression. Wilcoxon tests confirmed higher anxiety scores across both sexes. Systolic and diastolic blood pressure and heart rate increased significantly, particularly among females (<i>p</i> < 0.001), whereas oxygen saturation remained stable. Eating patterns shifted on ED, with higher consumption of fried foods, sweet bread, and sugar-sweetened beverages (<i>p</i> < 0.001), especially among males, and decreased intake of meat protein and vegetables, particularly among females. Meat consumption was significantly associated with increased anxiety (adjusted RR = 3.405; 95% CI: 1.035-11.194; <i>p</i> = 0.044). <b>Conclusions:</b> High-stakes academic exams in SSBM settings are associated with acute increases in anxiety and unhealthy dietary changes, even without significant depressive symptoms. These findings highlight the need for interventions supporting emotional regulation and healthy lifestyle behaviors among students facing academic stress in non-traditional educational environments.