Objective: To understand the relationships between screen time, physical activity, as well as neck and shoulder pain among university students in Tianjin. Methods: In this study, 904 university students in Tianjin were investigated using the Chinese Musculos Keletal Questionnaire during April-June 2021. Binary Logistic regression analysis was used to understand the neck and shoulder pain and the correlation between screen time and physical activity. Results: There was significant gender differences in the prevalence of neck and shoulder pain ( χ 2=24.35, P <0.05). Binary Logistic regression analysis showed that among male students, the risk of neck and shoulder pain whose screen time more than 6 h/d was 4.55 times that of those with screen time ≤2 h/d, among female students, the risk of neck and shoulder pain whose exercise time ＞150 min/week was 0.63 times than that of students who exercised ≤75 min/week( P <0.05). Among undergraduate and graduate students, physical activity ≥150 min/d was associated with lower rate of neck and shoulder pain( OR =0.52, 1.26, 0.61), while screen time ≥6 h/d was associated with higher rate of neck and shoulder pain( OR =2.39, 6.18, 2.97), and the differences were statistically significant ( P ＜0.05). The prevalence of neck and shoulder pain were higher in male students as well as undergraduate and graduate students who had higher screen time and higher physical activity than those with lower screen time and higher physical activity ( OR =2.96, 2.35, 2.93)( P <0.05). Conclusion High screen time and physical inactivity is associated with higher risk of neck and shoulder pain among college students. The effect of physical inactivity on neck and shoulder pain might be weaker than that of screen time. It is suggested that schools and families should cooperate to control screen activity and increase physical inactivity, so as to prevent the occurrence of neck and shoulder pain in college students.