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Objective: To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students. Design: An online survey was administered. Food insecurity was assessed using the 10-item Adult Food Security Survey Module. Sleep was measured using the 19-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health. Setting: Twenty-two higher education institutions. Participants: College students (n=17,686) enrolled at one of 22 participating universities. Results: Compared to food secure students, those classified as food insecure (43.4%) had higher PSQI scores indicating poorer sleep quality (p<.0001) and reported more days with poor mental (p<.0001) and physical (p<.0001) health as well as days when mental and physical health prevented them from completing daily activities (p<.0001). Food insecure students had higher adjusted odds of having poor sleep quality (adjusted odds ratio [AOR]:1.13, 95% confidence interval [CI]: 1.12-1.14), days with poor physical health (AOR: 1.01, 95% CI: 1.01-1.02), days with poor mental health (AOR: 1.03, 95% CI: 1.02-1.03), and days when poor mental or physical health prevented them from completing daily activities (AOR: 1.03, 95% CI: 1.02-1.04). Conclusions: College students report high food insecurity which is associated with poor mental and physical health and sleep quality. Multi-level policy changes and campus wellness programs are needed to prevent food insecurity and improve student health-related outcomes.

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