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American Indian/Alaska Native (AI/AN) individuals experience significant health disparities, including poor sleep health and cardiometabolic disease, and these risks emerge early in life. Food insecurity (lack of consistent access to healthy foods) is an important social determinant of health, and AI/AN people are one of the highest risk groups for experiencing food insecurity. Yet, little is known about how food insecurity contributes to health outcomes in urban AI/AN youth. This is the first study to examine the association between food insecurity and sleep (both self-reported sleep disturbance and a composite index of sleep health) and cardiometabolic outcomes in urban AI/AN youth, and whether sleep may be an indirect path between food insecurity and cardiometabolic outcomes. Methods Participants were 142 urban AI/AN youth (mean age = 14, 58% female, 53% living in single-parent households). The Child Food Security Survey Module assessed food insecurity. Sleep disturbance was measured using the School Sleep Health Survey. A multi-dimensional sleep health composite was derived using questionnaire measures (i.e., satisfaction, alertness) and actigraphy-derived indices (i.e., duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index (BMI), blood pressure, glycosylated hemoglobin (HbA1c), waist circumference, cholesterol, and triglycerides. Covariates were sex and age, and single-parent household. Results Greater food insecurity was significantly associated with greater BMI (b = 0.12, p = 0.015), higher systolic blood pressure (b = 0.93, p = 0.03), and greater sleep disturbance (b = 1.49, p &amp;lt; .001), and marginally associated with poorer sleep health via the sleep health composite (b = -0.09, p = 0.08). Food insecurity was not associated with any other cardiometabolic outcomes. There was a significant indirect path from greater food insecurity to greater waist circumference through lower sleep health composite score (0.11, 95% bootstrapping CI: [0.01, 0.30]). Conclusion Food insecurity is an important social determinant of sleep and cardiometabolic health. This is the first study of these associations in urban AI/AN youth. Sleep health may be an important, modifiable intervention target to mitigate the negative impact of food insecurity and reduce cardiometabolic risks in this vulnerable population. Support (if any) NIMHD R01MD012190

167 Food Insecurity and Cardiometabolic Risks in Urban American Indian/Alaska Native (AI/AN) Youth: The Role of Sleep Health