Cumulative risk assessment (CRA) is key to characterizing health risks in fence line and disadvantaged communities, which face environ-mental pollution and challenging socioeconomic conditions. Traditional approaches for inclusion of mixtures in CRA are limited and only assess the most sensitive target organ system for each chemical.

ABSTRACT
The objective of this study was to examine the influence of air quality (PM2.5, SO2, O3, and
NO2) on daily school absenteeism rates in students with and without asthma in an
underserved community with elevated exposure risk. This retrospective study analyzed
daily attendance and OAP exposure data from 2015/16 to 2017/18 in an environmental

justice area located in Pittsburgh, Pennsylvania. For students with asthma, both long-
term (28-day) and short-term (previous day) exposure to these PM2.5 levels 10.0–12.0 μg/

m3 significantly increased absenteeism compared to days with levels below 10 μg/m3
(RR = 1.27, 95% CI 1.10, 1.45 and RR = 1.21, 95% CI 1.03, 1.42, respectively, p < .05).
Exposure to unhealthy SO2 levels (≥75 ppb) also contributed to increased absenteeism
(RR = 1.85, 95% CI 1.17–2.92, p < .05). These findings suggest that, while the EPA’s recent
reduction in the PM2.5 good air quality standard threshold to 9 μg/m3 represents an
important step toward protecting sensitive groups, it does not fully safeguard children in
areas prone to frequent exceedances. The study underscores the importance of reducing
exposure to outdoor air pollutants in at-risk populations, as inequities in childhood
exposure can persist throughout life and disproportionately impact marginalized
communities.

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