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It is challenging to evaluate associations between the food environment near schools with either prevalence of childhood obesity or with socioeconomic characteristics of schools. This is because the food environment has many dimensions, including its spatial distribution. We used latent class analysis to classify public schools in urban, suburban, and rural areas in California into food environment classes based on the availability and spatial distribution of multiple types of unhealthy food outlets nearby. All urban schools had at least one unhealthy food outlet nearby, compared to seventy-two percent of schools in rural areas did. Food environment classes varied in the quantity of available food outlets, the relative mix of food outlet types, and the outlets’ spatial distribution near schools. Regardless of urbanicity, schools in low-income neighborhoods had greater exposure to unhealthy food outlets. The direction of associations between food environment classes and school size, type, and race/ethnic composition depends on the level of urbanicity of the school locations. Urban schools attended primarily by African American and Asian children are more likely to have greater exposures to unhealthy food outlets. In urban and rural but not suburban areas, schools attended primarily by Latino students had more outlets offering unhealthy foods or beverages nearby. In suburban areas, differences in the spatial distribution of food outlets indicates that food outlets are more likely to cluster near K-12 schools and high schools compared to elementary schools. Intervention design and future research need to consider that the associations between food environment exposures and school characteristics differ by urbanicity.

Most US children do not achieve the recommended daily 60 minutes of moderate to vigorous physical activity (PA). Schools are ideal settings to promote PA given their reach to large child populations, including students with less resources and limited access to PA opportunities. Although limited in numbers, schools that offer enough PA strategies can provide insights to increase PA in these settings. However, few studies have examined why and how these schools successfully prioritize PA strategies, particularly schools serving socioeconomically disadvantaged student populations. This qualitative study of low-resource, PA-supportive schools was conducted during 2017–2018 to obtain in-depth information about why and how schools make decisions to prioritize and implement PA strategies. Forty-two study participants in 17 states plus Washington DC were recruited. Content analysis revealed the following themes: (1) Schools prioritize PA because it helps advance learning and health goals; (2) Policies and standards for PA/PE reinforce the importance of PA; (3) A culture of learning and health advances decisions to offer PA; (4) Advocates play a key role in generating support to integrate PA; (5) Stakeholder buy-in enables decisions to offer PA opportunities; (6) Collaboration focused on PA specifically can facilitate decisions to increase PA strategies; and (7) Funding and resources drive decisions to put PA strategies into practice. The study findings offer insights that may be useful in efforts to increase access to PA opportunities in low-resource elementary schools.