**Background:** Food insecurity, defined as limited ability to access sufficient food for an active healthy life, affected approximately 38 million people in the United States in 2020. It disproportionately impacts minoritized racial/ethnic groups, with non-Hispanic Black (21.7%) and Hispanic/Latinx (17.2%) households experiencing higher prevalence compared to non-Hispanic White households (7.1%). Food insecurity may affect sleep through biological pathways (malnutrition, immune deficiency, chronic inflammation), psychological pathways (distress activating the HPA axis), and social pathways (limited access to grocery stores, structural racism). Despite the importance of both food insecurity and sleep as modifiable health factors, few studies have examined their relationship across diverse racial/ethnic groups, and even fewer have included non-Hispanic Asian populations or assessed multiple sleep dimensions beyond duration.
**Methods:** Data were obtained from the National Health Interview Survey (NHIS), an annual cross-sectional household survey of non-institutionalized US adults using a three-stage stratified cluster probability sampling design. The study included 177,435 participants aged ≥18 years from 2013–2018 after excluding those with missing data on food security, sleep, or race/ethnicity, as well as Native American and multiracial participants due to small sample size. Food security status was measured using the 10-item US Household Food Security Survey Module and categorized as high (0), marginal (1–2), low (3–5), and very low (6–10) based on USDA coding. Sleep outcomes included self-reported sleep duration (very short <6h, short <7h, recommended 7–9h, long ≥9h) and sleep disturbances (trouble falling asleep ≥3 nights/week, trouble staying asleep ≥3 nights/week, insomnia symptoms, waking up unrested ≥3 days/week, sleep medication use ≥3 nights/week). Poisson regression with robust variance was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI), adjusting for age, race/ethnicity, sex/gender, educational attainment, annual household income, employment status, occupational class, region, and marital status.
**Key Results:** Among 177,435 participants (mean age 47.2 years, 52.0% women), 82.9% lived in households with high food security, 6.8% marginal, 5.7% low, and 4.5% very low. NH-Black participants had the highest proportion of very low food security (23.9%) compared to NH-White (54.4%), Hispanic/Latinx (19.3%), and NH-Asian (2.4%). Overall, 64.4% reported recommended sleep (7–9h), while 9.1% reported very short sleep (<6h) and 31.5% short sleep (<7h). The most common sleep problem was waking up feeling unrested (43.0%), followed by insomnia symptoms (33.2%). Participants with very low vs. high food security had significantly higher prevalence of very short sleep (PR=2.61, 95% CI 2.44–2.80), trouble falling asleep (PR=2.21, 95% CI 2.12–2.30), and sleep medication use (PR=2.22, 95% CI 2.07–2.37). A dose-response relationship was observed across food security levels. By race/ethnicity, very low vs. high food security was associated with very short sleep among NH-Asian (PR=3.64, 95% CI 2.67–4.97), NH-White (PR=2.73, 95% CI 2.50–2.99), Hispanic/Latinx (PR=2.65, 95% CI 2.30–3.07), and NH-Black (PR=2.03, 95% CI 1.80–2.31) adults. Hispanic/Latinx participants with very low vs. high food security had the strongest associations with sleep disturbances: trouble falling asleep (PR=2.47, 95% CI 2.24–2.73), trouble staying asleep (PR=2.18, 95% CI 1.97–2.41), insomnia symptoms (PR=2.12, 95% CI 1.95–2.31), and sleep medication use (PR=2.76, 95% CI 2.32–3.29). Compared to NH-White participants with high food security, NH-Black participants with very low food security had 2.81 times the prevalence of very short sleep (95% CI 2.50–3.16), while NH-Asian participants with very low food security had 3.75 times the prevalence (95% CI 2.83–4.95).
**Clinical Implications:** This study demonstrates that food insecurity is strongly and consistently associated with poorer sleep health across multiple dimensions in a racially/ethnically diverse US population. The findings identify NH-Black, Hispanic/Latinx, and NH-Asian adults as disproportionately affected by food insecurity and its sleep-related consequences, highlighting the need for targeted interventions. Clinicians should consider screening for food insecurity when evaluating patients with sleep complaints, particularly among minoritized populations. Policy interventions addressing upstream determinants—including expansion of federal assistance programs like SNAP, improving food access through transportation and community gardens, and climate change mitigation—may help reduce both food insecurity and sleep health disparities. The cross-sectional design limits causal inference, and future longitudinal studies with objective sleep measures are needed to elucidate mechanisms and temporal relationships.