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Your Environment. Your Health.

Chronic Disease Epidemiology Group

Environmental Exposures and Chronic Disease Risk

Photo of Sandler, Dale P.
Dale Sandler, Ph.D.
Chief, Epidemiology Branch and Senior Investigator
Tel 984-287-3711
Fax 301-480-3290
sandler@niehs.nih.gov
P.O. Box 12233
Mail Drop A3-05
Durham, N.C. 27709

Research Summary

Chronic Disease Epidemiology Group Image

The Chronic Disease Epidemiology Group studies a wide range of chronic diseases and conditions. Work takes advantage of large prospective cohort studies developed to study the impact of environmental and lifestyle exposures on population health. These cohorts allow for both hypothesis driven and opportunistic research, enabling the group to explore outcomes not envisioned when the cohorts were designed, and foster translational and cross-disciplinary research.

The group includes three Staff Scientists and an Associate Investigator working under an Interagency Personnel Act Agreement who serve as lead investigators for research involving the Epidemiology Branch cohorts and conduct related research.

  • Richard Kwok Ph.D. is Staff Scientist and Co-PI of the Gulf Long-term Follow-up Study (GuLF Study). He conducts research on disaster-related mental and physical health effects of oil spills.
  • Lawrence Engel, Ph.D., Associate Professor of Epidemiology at the Gillings School of Global Public Health, University of North Carolina, serves, along with Sandler and Kwok, as Co-PI of the GuLF Study.
  • Katie O'Brien, Ph.D., is Staff Scientist and Lead Investigator for the Sister Study and conducts research on factors that affect risk for breast, ovarian, and uterine cancers.
  • Christine Parks, Ph.D. is Staff Scientist for the Agricultural Health Study (AHS) and conducts research on autoimmune diseases. As AHS co-investigator she coordinates collaborations with the NCI and other intramural and extramural investigators.

The Chronic Disease Epidemiology Group is headed by Dale Sandler, Ph.D., who also is Chief of the Epidemiology Branch in the Division of Intramural Research at NIEHS. Sandler is adjunct professor of Epidemiology in the Gillings School of Global Public Health, University of North Carolina at Chapel Hill. She received an M.P.H. from Yale University and a Ph.D. in Epidemiology from The Johns Hopkins University. In 2015, she won the Nathan Davis Award for Outstanding Government Service from the American Medical Association. She has received several NIEHS and NIH merit awards and received awards for mentoring in 2013 and 2019.

Sandler’s research takes advantage of large prospective cohort studies that she developed. Interests include health effects of pesticides and oil spill related exposures and the influence of environmental and lifestyle exposures across the lifespan in relation to risk for breast cancer and other cancers and non-cancer chronic diseases.

In 1990, Sandler joined forces with the National Cancer Institute to develop the Agricultural Health Study, an ongoing prospective study of licensed pesticide applicators and their spouses. Sandler expanded the focus to include non-cancer outcomes. Her group has linked pesticides and other agricultural exposures to risk for Parkinson’s disease, respiratory disease, diabetes, thyroid disease, End Stage Renal Disease (ESRD), rheumatoid arthritis, and shingles (herpes zoster).

Sandler is Principal Investigator of The Sister Study, a prospective cohort of over 50,000 women with enhanced risk for breast cancer due to having had a sister who was diagnosed with the disease. Sandler’s group studies early life, reproductive, dietary, lifestyle, and environmental factors related to breast cancer risk. The group studies genetic factors (e.g. gene variation, telomere length, methylation) in relation to breast and other cancers through collaborations with other NIEHS groups and participation in large consortia. Using this cohort, the Chronic Disease Epidemiology group also studies other conditions, including obesity, thyroid disease, diabetes, autoimmune diseases, hypertension, and neurological health. With Hazel Nichols (UNC) and Anthony Swerdlow and Minouk Shoemaker (The Institute of Cancer Research, London UK), Sandler established the Premenopausal Breast Cancer Collaborative Group, a consortia of 24 prospective cohorts world-wide (including the Sister Study) to study risk factors for breast cancer diagnosed before 55 in a pooled dataset.

With Richard Kwok, Ph.D. and Lawrence Engel, Ph.D. Sandler initiated the GuLF Study, a prospective cohort study of persons who were involved in some aspect of oil spill response and clean-up following the April 2010 Deepwater Horizon disaster in the Gulf of Mexico. Nearly 33,000 persons enrolled between March 2011 and March 2013 and a subgroup of 11,200 Gulf state residents completed home visits that included collection of biological and environmental samples, and measurement of lung function and blood pressure. Follow-up includes record linkage and telephone interviews, as well as a clinic exam completed by participants living within 60 miles of a study clinic. Outcomes of interest include respiratory and neurological function, and cardiovascular, metabolic, and mental health. Sandler's group also considers the impact of socioeconomic and climate-related factors in this disadvantaged and vulnerable cohort.

Studies

  • The Agricultural Health Study (AHS):
    Study website: www.aghealth.nih.gov

    The AHS explores a wide range of health outcomes among licensed pesticide applicators and their spouses potentially exposed to pesticides and other agricultural hazards. The study includes about 52,000 private pesticide applicators, mostly farmers, from Iowa and North Carolina, 32,000 spouses of married private applicators, and nearly 5,000 commercial pesticide applicators from Iowa, who have been followed since enrollment in 1993–1997. Focused add-on studies led by extramural and NIEHS collaborators currently include research on outcomes associated with neurodegeneration such as loss of sense and smell (Michigan State University) and cognitive decline (Duke University), and the AHS Lung Health Study led by Stephanie London at NIEHS.

  • GuLF STUDY:
    Study website: www.gulfstudy.nih.gov

    The Gulf Long-term Follow-up Study (GuLF Study) is investigating potential health effects associated with response and clean-up activities following the 2010 Deepwater Horizon disaster in the Gulf of Mexico. Nearly 33,000 persons who performed oil-spill related work or received safety training but did not participate in the oil spill response enrolled in the study between March 2011 and March 2013 by completing comprehensive telephone questionnaires about work experiences and health. Nearly 11,200 persons from Gulf states completed home exams that included additional questionnaires, collection of biological and environmental samples, and measurement of lung function and blood pressure. Ongoing follow-up includes telephone interviews, a clinical exam, and linkage to the National Death Index and cancer registries in the Gulf states.

  • The Sister Study:
    Study website: https://sisterstudy.niehs.nih.gov

    The Sister Study is prospectively examining environmental and familial risk factors for breast cancer and other diseases in a cohort of over 50,000 sisters of women who have had breast cancer. Breast cancer-free participants aged 35-74 from across the U.S. and Puerto Rico who had a sister diagnosed with breast cancer enrolled in 2003-2009 by providing questionnaire data about life-time exposures and completing home exams including collection of biological samples. Participants are being followed with brief annual updates and periodic comprehensive questionnaires. More than 4,150 participants have been diagnosed with breast cancer through September 2019.

Selected Publications

  1. Parks CG, Hofmann JN, Beane Freeman LE, Sandler DP. 2021. Agricultural Pesticides and Shingles Risk in a Prospective Cohort of Licensed Pesticide Applicators. Environ Health Perspect 129(7):77005. [Abstract Parks CG, Hofmann JN, Beane Freeman LE, Sandler DP. 2021. Agricultural Pesticides and Shingles Risk in a Prospective Cohort of Licensed Pesticide Applicators. Environ Health Perspect 129(7):77005.]
  2. Park YM, Bookwalter DB, O'Brien KM, Jackson CL, Weinberg CR, Sandler DP. A prospective study of type 2 diabetes, metformin use, and risk of breast cancer. Ann Oncol. 2021 Mar;32(3):351-359. doi: 10.1016/j.annonc.2020.12.008. Epub 2021 Jan 29. PMID: 33516778; PMCID: PMC7995619. [Abstract Park YM, Bookwalter DB, O'Brien KM, Jackson CL, Weinberg CR, Sandler DP. A prospective study of type 2 diabetes, metformin use, and risk of breast cancer. Ann Oncol. 2021 Mar;32(3):351-359. doi: 10.1016/j.annonc.2020.12.008. Epub 2021 Jan 29. PMID: 33516778; PMCID: PMC7995619.]
  3. O'Brien KM, Tworoger SS, Harris HR, Trabert B, Weinberg CR, Fortner RT, D'Aloisio AA, Kaunitz AM, Wentzensen N, Sandler DP. Genital powder use and risk of uterine cancer: A pooled analysis of prospective studies. Int J Cancer. 2021 Jun 1;148(11):2692-2701. doi: 10.1002/ijc.33470. Epub 2021 Feb 1. PMID: 33433939; PMCID: PMC8106926. [Abstract O'Brien KM, Tworoger SS, Harris HR, Trabert B, Weinberg CR, Fortner RT, D'Aloisio AA, Kaunitz AM, Wentzensen N, Sandler DP. Genital powder use and risk of uterine cancer: A pooled analysis of prospective studies. Int J Cancer. 2021 Jun 1;148(11):2692-2701. doi: 10.1002/ijc.33470. Epub 2021 Feb 1. PMID: 33433939; PMCID: PMC8106926.]
  4. Lawrence KG, Kresovich JK, O'Brien KM, Hoang TT, Xu Z, Taylor JA, Sandler DP. Association of Neighborhood Deprivation With Epigenetic Aging Using 4 Clock Metrics. JAMA Netw Open. 2020 Nov 2;3(11):e2024329. doi: 10.1001/jamanetworkopen.2020.24329. PMID: 33146735; PMCID: PMC7643028. [Abstract Lawrence KG, Kresovich JK, O'Brien KM, Hoang TT, Xu Z, Taylor JA, Sandler DP. Association of Neighborhood Deprivation With Epigenetic Aging Using 4 Clock Metrics. JAMA Netw Open. 2020 Nov 2;3(11):e2024329. doi: 10.1001/jamanetworkopen.2020.24329. PMID: 33146735; PMCID: PMC7643028.]
  5. Shrestha S, Parks CG, Umbach DM, Richards-Barber M, Hofmann JN, Chen H, Blair A, Beane Freeman LE, Sandler DP. Pesticide use and incident Parkinson's disease in a cohort of farmers and their spouses. Environ Res. 2020 Dec;191:110186. doi: 10.1016/j.envres.2020.110186. Epub 2020 Sep 10. PMID: 32919961; PMCID: PMC7822498. [Abstract Shrestha S, Parks CG, Umbach DM, Richards-Barber M, Hofmann JN, Chen H, Blair A, Beane Freeman LE, Sandler DP. Pesticide use and incident Parkinson's disease in a cohort of farmers and their spouses. Environ Res. 2020 Dec;191:110186. doi: 10.1016/j.envres.2020.110186. Epub 2020 Sep 10. PMID: 32919961; PMCID: PMC7822498.]
  6. O'Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D'Aloisio AA, Sandler DP, Wentzensen N. Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. JAMA. 2020 Jan 7;323(1):49-59. doi: 10.1001/jama.2019.20079. PMID: 31910280; PMCID: PMC6990816. [Abstract O'Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D'Aloisio AA, Sandler DP, Wentzensen N. Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. JAMA. 2020 Jan 7;323(1):49-59. doi: 10.1001/jama.2019.20079. PMID: 31910280; PMCID: PMC6990816.]
  7. Eberle CE, Sandler DP, Taylor KW, White AJ. Hair dye and chemical straightener use and breast cancer risk in a large US population of black and white women. Int J Cancer. 2020 Jul 15;147(2):383-391. doi: 10.1002/ijc.32738. Epub 2019 Dec 3. PMID: 31797377; PMCID: PMC7246134. [Abstract Eberle CE, Sandler DP, Taylor KW, White AJ. Hair dye and chemical straightener use and breast cancer risk in a large US population of black and white women. Int J Cancer. 2020 Jul 15;147(2):383-391. doi: 10.1002/ijc.32738. Epub 2019 Dec 3. PMID: 31797377; PMCID: PMC7246134.]
  8. Park YM, White AJ, Jackson CL, Weinberg CR, Sandler DP. Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. JAMA Intern Med. 2019 Aug 1;179(8):1061-1071. doi: 10.1001/jamainternmed.2019.0571. PMID: 31180469; PMCID: PMC6563591. [Abstract Park YM, White AJ, Jackson CL, Weinberg CR, Sandler DP. Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. JAMA Intern Med. 2019 Aug 1;179(8):1061-1071. doi: 10.1001/jamainternmed.2019.0571. PMID: 31180469; PMCID: PMC6563591.]
  9. Nichols HB, Schoemaker MJ, Cai J, Xu J, Wright LB, Brook MN, Jones ME, Adami HO, Baglietto L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kitahara CM, Larsson SC, Linet M, Merritt MA, Milne RL, Pala V, Palmer JR, Peeters PH, Riboli E, Sund M, Tamimi RM, Tjønneland A, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Wolk A, Zheng W, Weinberg CR, Swerdlow AJ, Sandler DP. Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. Ann Intern Med. 2019 Jan 1;170(1):22-30. doi: 10.7326/M18-1323. Epub 2018 Dec 11. PMID: 30534999; PMCID: PMC6760671. [Abstract Nichols HB, Schoemaker MJ, Cai J, Xu J, Wright LB, Brook MN, Jones ME, Adami HO, Baglietto L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kitahara CM, Larsson SC, Linet M, Merritt MA, Milne RL, Pala V, Palmer JR, Peeters PH, Riboli E, Sund M, Tamimi RM, Tjønneland A, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Wolk A, Zheng W, Weinberg CR, Swerdlow AJ, Sandler DP. Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. Ann Intern Med. 2019 Jan 1;170(1):22-30. doi: 10.7326/M18-1323. Epub 2018 Dec 11. PMID: 30534999; PMCID: PMC6760671.]
  10. Shrestha S, Parks CG, Goldner WS, Kamel F, Umbach DM, Ward MH, Lerro CC, Koutros S, Hofmann JN, Beane Freeman LE, Sandler DP. Pesticide Use and Incident Hypothyroidism in Pesticide Applicators in the Agricultural Health Study. Environ Health Perspect. 2018 Sep;126(9):97008. doi: 10.1289/EHP3194. PMID: 30256155; PMCID: PMC6375417. [Abstract Shrestha S, Parks CG, Goldner WS, Kamel F, Umbach DM, Ward MH, Lerro CC, Koutros S, Hofmann JN, Beane Freeman LE, Sandler DP. Pesticide Use and Incident Hypothyroidism in Pesticide Applicators in the Agricultural Health Study. Environ Health Perspect. 2018 Sep;126(9):97008. doi: 10.1289/EHP3194. PMID: 30256155; PMCID: PMC6375417.]
  11. Premenopausal Breast Cancer Collaborative Group, Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami HO, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault MC, Braaten T, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh WP, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Peeters PH, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan JM, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Association of Body Mass Index and Age With Subsequent Breast Cancer Risk in Premenopausal Women. JAMA Oncol. 2018 Nov 1;4(11):e181771. doi: 10.1001/jamaoncol.2018.1771. Epub 2018 Nov 8. PMID: 29931120; PMCID: PMC6248078. [Abstract Premenopausal Breast Cancer Collaborative Group, Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami HO, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault MC, Braaten T, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh WP, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Peeters PH, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan JM, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Association of Body Mass Index and Age With Subsequent Breast Cancer Risk in Premenopausal Women. JAMA Oncol. 2018 Nov 1;4(11):e181771. doi: 10.1001/jamaoncol.2018.1771. Epub 2018 Nov 8. PMID: 29931120; PMCID: PMC6248078.]
  12. Gam KB, Kwok RK, Engel LS, Curry MD, Stewart PA, Stenzel MR, McGrath JA, Jackson WB 2nd, Jensen RL, Keil AP, Lichtveld MY, Miller AK, Sandler DP. Lung Function in Oil Spill Response Workers 1-3 Years After the Deepwater Horizon Disaster. Epidemiology. 2018 May;29(3):315-322. doi: 10.1097/EDE.0000000000000808. PMID: 29381492; PMCID: PMC5882518. [Abstract Gam KB, Kwok RK, Engel LS, Curry MD, Stewart PA, Stenzel MR, McGrath JA, Jackson WB 2nd, Jensen RL, Keil AP, Lichtveld MY, Miller AK, Sandler DP. Lung Function in Oil Spill Response Workers 1-3 Years After the Deepwater Horizon Disaster. Epidemiology. 2018 May;29(3):315-322. doi: 10.1097/EDE.0000000000000808. PMID: 29381492; PMCID: PMC5882518.]
  13. Sandler DP, Hodgson ME, Deming-Halverson SL, Juras PS, D'Aloisio AA, Suarez LM, Kleeberger CA, Shore DL, DeRoo LA, Taylor JA, Weinberg CR; Sister Study Research Team. The Sister Study Cohort: Baseline Methods and Participant Characteristics. Environ Health Perspect. 2017 Dec 20;125(12):127003. doi: 10.1289/EHP1923. PMID: 29373861; PMCID: PMC5963586. [Abstract Sandler DP, Hodgson ME, Deming-Halverson SL, Juras PS, D'Aloisio AA, Suarez LM, Kleeberger CA, Shore DL, DeRoo LA, Taylor JA, Weinberg CR; Sister Study Research Team. The Sister Study Cohort: Baseline Methods and Participant Characteristics. Environ Health Perspect. 2017 Dec 20;125(12):127003. doi: 10.1289/EHP1923. PMID: 29373861; PMCID: PMC5963586.]
  14. Kwok RK, McGrath JA, Lowe SR, Engel LS, Jackson WB Nd, Curry MD, Payne J, Galea S, Sandler DP. Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the GuLF STUDY cohort. Lancet Public Health. 2017 Dec;2(12):e560-e567. doi: 10.1016/S2468-2667(17)30194-9. Epub 2017 Oct 27. PMID: 29253441; PMCID: PMC6051348. [Abstract Kwok RK, McGrath JA, Lowe SR, Engel LS, Jackson WB Nd, Curry MD, Payne J, Galea S, Sandler DP. Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the GuLF STUDY cohort. Lancet Public Health. 2017 Dec;2(12):e560-e567. doi: 10.1016/S2468-2667(17)30194-9. Epub 2017 Oct 27. PMID: 29253441; PMCID: PMC6051348.]
  15. Meyer A, Sandler DP, Beane Freeman LE, Hofmann JN, Parks CG. Pesticide Exposure and Risk of Rheumatoid Arthritis among Licensed Male Pesticide Applicators in the Agricultural Health Study. Environ Health Perspect. 2017 Jul 14;125(7):077010. doi: 10.1289/EHP1013. PMID: 28718769; PMCID: PMC5744649. [Abstract Meyer A, Sandler DP, Beane Freeman LE, Hofmann JN, Parks CG. Pesticide Exposure and Risk of Rheumatoid Arthritis among Licensed Male Pesticide Applicators in the Agricultural Health Study. Environ Health Perspect. 2017 Jul 14;125(7):077010. doi: 10.1289/EHP1013. PMID: 28718769; PMCID: PMC5744649.]
  16. Kwok RK, Engel LS, Miller AK, Blair A, Curry MD, Jackson WB, Stewart PA, Stenzel MR, Birnbaum LS, Sandler DP; GuLF STUDY Research Team. The GuLF STUDY: A Prospective Study of Persons Involved in the Deepwater Horizon Oil Spill Response and Clean-Up. Environ Health Perspect. 2017 Apr;125(4):570-578. doi: 10.1289/EHP715. Epub 2017 Mar 31. PMID: 28362265; PMCID: PMC5382003. [Abstract Kwok RK, Engel LS, Miller AK, Blair A, Curry MD, Jackson WB, Stewart PA, Stenzel MR, Birnbaum LS, Sandler DP; GuLF STUDY Research Team. The GuLF STUDY: A Prospective Study of Persons Involved in the Deepwater Horizon Oil Spill Response and Clean-Up. Environ Health Perspect. 2017 Apr;125(4):570-578. doi: 10.1289/EHP715. Epub 2017 Mar 31. PMID: 28362265; PMCID: PMC5382003.]
For a complete list of Sandler's publications, see sandler dp - Search Results - PubMed (nih.gov)
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