ABSTRACT
Objective: Sleep difficulty is one of the main concerns during the COVID-19 pandemic. This study examined factors related to vaccination and physical and psychological health conditions, and sleep difficulty in college students in China. Methods: An online, cross-sectional, anonymous survey was used to investigate college students' perceived sleep difficulty and relevant components (i.e., physical health condition, psychological distress, knowledge of vaccine, and autonomy of vaccine uptake). Hierarchical ordinal logistic regression was conducted to examine the proposed model with the control of participants' demographics (i.e., gender and age). Results: Valid data of 3,145 students from 43 universities in mainland China was collected in January 2021. The average age of participants was 20.8 years old (S. D. = 2.09). The majority were single (97.4%), and about half were male (49.8%). Results showed that participants had less psychological distress when they had more knowledge about the COVID-19 vaccine and more autonomy to decide whether to receive it. In addition, participants with better physical health experienced less sleep difficulty. In contrast, those with more psychological distress experienced more sleep difficulty. Conclusions: These findings can inform healthcare providers about the relationship between different factors and difficulty sleeping and aid them in developing interventions addressing sleep difficulties associated with the global pandemic. Health authorities also can improve vaccine uptake and reduce hesitancies in future vaccination campaigns based on the study results showing that greater vaccine knowledge and autonomy reduced psychological distress.