title: A School-Level Proxy Measure for Individual-Level Poverty Using School-Level Eligibility for Free and Reduced-Price Meals.
abstract: BACKGROUND
  Socioeconomic status (SES) impacts health outcomes. The Youth Risk Behavior Survey (YRBS), like many school-based data sources, lacks individual-level poverty information. We propose using school-level percentages of student eligibility for free/reduced-price meals (%FRPM) as a proxy for individual-level poverty.
  
  
  METHODS
  Using the New York City (NYC) 2009 YRBS, we created school-level poverty quartiles to append to individual YRBS records by ranking schools by %FRPM. We compared this with 2 other school-level poverty measures using students' home and school neighborhood-level poverty and measured the association of these 3 school-level proxies with individual's household income. Last, we evaluated health outcomes by race/ethnicity and poverty to demonstrate the importance of accounting for poverty.
  
  
  RESULTS
  The school-level measure that used %FRPM had the strongest association with household income. When the school-level individual poverty proxy was included in illustrative analyses using YRBS data, patterns by poverty within race/ethnicity emerged that were not seen when looking at race/ethnicity alone.
  
  
  CONCLUSIONS
  Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. sday@health.nyc.gov.
authors.forename: Sophia E
authors.identifier: http://orcid.org/0000-0003-1885-5907
authors.initials: SE
authors.lastname: Day
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. khinterl@health.nyc.gov.
authors.forename: Kinjia
authors.initials: K
authors.lastname: Hinterland
authors.affiliation: Center for Health Equity, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. cmyers@health.nyc.gov.
authors.forename: Christa
authors.initials: C
authors.lastname: Myers
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. lsgupta@gmail.com.
authors.forename: Leena
authors.initials: L
authors.lastname: Gupta
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. th2604@columbia.edu.
authors.forename: Tiffany G
authors.initials: TG
authors.lastname: Harris
authors.affiliation: Division of Epidemiology, New York City Department of Health and Mental Hygiene, 42-09 28th St., Long Island City, NY 11101. kkonty@health.nyc.gov.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Konty
mesh_terms: D005260:Female; D005522:Food Services / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D062407:Meals; D009519:New York City; D011159:Population Surveillance / Q000379:methods; D011203:Poverty / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data*
keywords: child and adolescent health; evaluation; health-risk behaviors; methods and materials of instruction; public health; research