Journal of Environmental and Public Health introduces a limitation due to subjectivity. Respondents may conceptualize the words “insuﬃcient” and “rest” diﬀerently. Some respondents may have conceptualized true sleep when self-reporting, while others may have considered sleep plus rest, such as time spent watching television. The subjectivity makes comparison to studies of objective measures of insuf- ﬁcient sleep, including polysomnography, diﬃcult. Fifth, the global SRH measure is also subjective and nonspeciﬁc, characteristics that may be viewed as limitations. However, the SRH measure’s reliability and repeatability has been conﬁrmed in multiple studies across several continents and various cultural settings [13, 22]. Furthermore, SRH has the potential to capture dimensions of health that are not covered in traditional, objective clinical examinations, which are more likely to be focussed around a particular organ system (e.g., cardiovascular system or gastrointestinal system), and may also account for slowly progressing diseases that evade clinical diagnoses [23]. Sixth, the BRFSS survey did not collect information on habitual sleep duration. Therefore, unfortunately, we are not able to examine if the relationship between insuﬃcient sleep and poor SRH is modiﬁed by habitual sleep duration. Finally, the insuﬃcient rest/sleep item newly included in the 2008 BRFSS has not been widely used or tested and therefore its reliability and validity remains questionable. However, widely tested and validated sleep quality instruments such as the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale do include similar items on perceived rest/sleep. Future studies examining the association between the insuﬃcient rest/sleep BRFSS item and objectively measured sleep duration (e.g., actigraphy) are needed. Future research should also include longitudinal studies to establish causation potentially includ- ing sleep duration interventions [10]. In summary, in a multiethnic, nationally representative sample of US adults, increasing categories of perceived insuf- ﬁcient rest/sleep was found to be positively associated with poor SRH. This association persisted independent of sex, age, race-ethnicity, education, employment, income, marital status, smoking, heavy alcohol intake, lack of exercise, overweight/obese BMI, CVD, depression, and anxiety. Based on this study, self-reported insuﬃcient rest/sleep appears to be a strong predictor of SRH. Conﬂict of Interests There are no conﬂicts of interest related to this paper. 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