Background: University-going women in Uganda face multiple lifestyle-related health risks that emerge from complex interactions between socioeconomic constraints, campus environments, cultural influences, and individual factors, yet comprehensive data on these patterns and their determinants remain limited. This study examined the prevalence, determinants, and health implications of lifestyle behaviors among female university students in Uganda. Methods: A cross-sectional analytical study was conducted among 842 randomly selected female undergraduate students aged 18-30 years from five universities (two public, three private) across different regions of Uganda. Data were collected using structured questionnaires incorporating validated instruments including the Global Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, Alcohol Use Disorders Identification Test, Patient Health Questionnaire-9, and WHO Quality of Life-BREF scale, alongside physical measurements and assessments of dietary practices, sexual behaviors, and sociodemographic characteristics. Statistical analysis employed univariate methods to describe prevalence with 95% confidence intervals, bivariate analysis using chi-square tests and t-tests to examine associations between determinants and behaviors, and structural equation modeling to test complex pathways between sociodemographic factors, environmental influences, lifestyle behaviors, and health outcomes including direct and indirect effects. Results: High prevalence rates of risky lifestyle behaviors were documented across all domains: 84.6% reported inadequate fruit and vegetable consumption, 75.8% had insufficient physical activity, 74.0% experienced poor sleep quality, 65.0% exhibited irregular eating patterns, 44.9% screened positive for moderate-to-severe depressive symptoms, and among sexually active participants, 60.0% reported inconsistent condom use. Bivariate analyses revealed significant associations between lifestyle behaviors and age (p