Air Pollution Raises Stroke Risk

Air pollution increases the risk of ischemic stroke by a small but significant amount, a new study finds.

Medicare records on more than 150,000 people hospitalized for stroke in nine U.S. cities found that an increase in air pollution from the lowest to the highest concentrations was associated with a 1.03 percent increase in incidence, according to the report in the Oct. 27 issue of Stroke.

"That doesn't sound like much, a small increase, but if you consider how many people are at risk for stroke, the absolute increase in incidence can be quite high," said study author Gregory Wellenius, a postdoctoral fellow in cardiology at Beth Israel Deaconess Medical Center in Boston.

Some 700,000 American suffer strokes each year, with the most common form being ischemic stroke, which occurs when a clot blocks a brain artery, according to the American Stroke Association.

The study concentrated on small particle pollutants, which are spewed from sources including car and truck exhausts, power plants and refineries. But it found a similar increase in risk for other pollutants -- carbon monoxide, nitrogen dioxide and sulfur dioxide.

Many studies have established a link between polluted air and heart attacks, heart failure and other cardiac problems. And previous studies have also pointed to an increased risk of stroke, Wellenius said. But this is the first to distinguish between ischemic strokes and hemorrhagic strokes, which occur when a blood vessel ruptures.

The study did not find an increased rate of hemorrhagic stroke associated with heavily polluted air. That could be due to the relatively small number of hospital admissions for such strokes, which makes it difficult to establish statistical significance, Wellenius said.

The researchers theorized that polluted air might increase ischemic stroke risk the same way it increases heart disease risk -- by promoting the formation of blood clots and causing fatty plaques in arteries to rupture.

More work is needed to firm up the association, Wellenius said. The current study was limited to people old enough to be in Medicare, "and we need to replicate this study in other populations," he said. A closer look at the effects of pollutants other than small particles is also needed, he added.

The study has strong regulatory implications, said Frank O'Donnell, president of Clean Air Watch, a nonprofit environmental organization.

The U.S. Environmental Protection Agency is under a court order to make a ruling by December on whether current federal standards are adequate to protect health, he said, and the study "is further evidence that fine-particle pollution is a significant public health risk."

"We should be doing much more to try to reduce this dangerous pollution," O'Donnell said.

Fine-particle pollution causes an estimated 20,000 premature deaths in the United States each year, he said. The EPA has proposed standards to reduce such pollution by diesel engines, "but they won't reach their peak potential until 2030," O'Donnell explained.

More information

Facts about the health effects of air pollution and how to protect against them are provided by the American Academy of Family Physicians.

On-Campus Suicide a Hidden Killer

Back in 1998, Ron Gibori was a fraternity brother to bright, popular Jed Satow, a 20-year-old University of Arizona sophomore whose suicide that year shocked his family and friends.

"I made a promise at his memorial service that I would try and do something to make sure other students like myself would never have to lose a friend," Gibori said.

Then, less than six months later, another of Gibori's fraternity brothers took his own life. "I realized then that the promise I had made at Jed's memorial service couldn't go unfulfilled," he said.

Joining forces with Jed's parents Phillip and Donna Satow, Gibori helped create The Jed Foundation, a New York City-based nonprofit organization dedicated to raising awareness of the problem of suicide on America's college campuses.

According to Gibori, approximately 1,100 U.S. college students take their own lives each year. Nobody's sure if that number is rising or falling -- according to Gibori, a steep increase in on-campus suicides has been charted over the past 40 years, but that could simply reflect a more honest reporting of an event that's been too long cloaked in shame.

"Suicide is still an unexplored social taboo in our society today," Gibori said. Breaking that taboo is the key goal of The Jed Foundation and its Web-based help service, www.Ulifeline.org.

Students in trouble who head to the site can get youth-friendly, anonymous mental health information, as well as links to on-campus mental health centers at more than 530 U.S. colleges. "Right now, over 5 million students have access to the program," Gibori said.

The need is real. According to Los Angeles psychologist Michael Peck, a specialist in youth suicide, college can be a dangerous time for troubled young people.

Many are emotionally immature, he said, and while their newfound independence from parents is liberating, it can be scary, too. Alcohol and drugs are readily available, and the pressure to achieve and fit in can be overwhelming, especially at prestige schools.

In fact, "a study I did years ago found that elite colleges have much higher suicide-event rates than small, local community colleges," Peck said. Much of that owes to the fact that students attending smaller, local colleges are also more likely to be living in the relative comfort and safety of the family home.

"Elite colleges also come with higher stress because there's much more pressure on succeeding," he said. "When students aren't succeeding, they feel like they're failing both themselves and their parents, who are often paying a lot of money for these schools."

And Peck pointed to another grim phenomenon: The fact that suicide can be "contagious" on campus. "Students are closely packed together, so a suicide attempt or death may trigger other suicidal behavior by other students," he said. "That's always a problem."

There are warning signs, he said:

• Apathy. "You'll see a drop-off in school participation, and a falling of grades and class attendance," Peck said.
• Distance. Friends and family may notice a change in closeness or communication. "This might not always be in terms of frequency," Peck noted. "The student may still call his parents every Sunday like he's supposed to; but instead of the usual conversation, it's just 'Hi Mom, Dad, everything's fine, talk to you later.'"
• Substance abuse. Friends, especially, should react to any abnormal increase in drinking or drug-taking behavior with concern, the psychologist said.
• Unexplained gifts. "This actually happens a lot," Peck said. "A student will come to you and say 'I know you're taking chemistry -- here are my books, I won't need them anymore.'" These types of acts are usually a cry for help, he said -- something friends need to be sensitive to.

"Friends are the key ingredient here," Peck said. "Usually, if the student is going to tell anybody that they are at risk, they'll tell a friend." And he believes those closest to at-risk students need to be "understanding, not dismissive," and urge them to head for mental-health counseling.

Parents can also play a key role. "They need to be open to that idea that there can always be problems," he said, and to ease up on the pressure if their child seems to be struggling at school.

If and when problems do surface, parents may need to take decisive action. "They even have to be willing, in extreme circumstances, to bring their child home," Peck said.

Colleges have done much to raise awareness of campus suicide in the past decade or two, Peck said. "Most have a hotline now, a mental-health service, specific rules about partying and hazing," he said.

And yet students like Jed Satow can still fall through the cracks.

"I think the thing people say most often is, 'This can never happen to me, or to my friend,'" Gibori said. "There's that perception out there that people who are depressed are all dressed in black, pierced and tattooed."

But even the most outwardly cheerful, wholesome students can be struggling with hidden demons.

"My two friends in the fraternity who took their lives were probably two of the most popular kids there -- the most liked and the most sociable," Gibori said. "So the key message is that if you don't want it to be you or your friend, get educated on the warning signs, and know that depression is treatable, because everyone is vulnerable."

More information

For much more on campus suicide risks and prevention, visit The Jed Foundation.