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Introduction to Forensic Epidemiology Goals Describe forensic epidemiology and the groups that may be involved in a forensic epidemiology investigation. Explain how forensic epidemiology is used in the courtroom and in the field. Provide examples when forensic epidemiology might be used. Definition of Epidemiology “The study of the distribution and determinants of health related states or events in populations, and the application of this study to control health problems” The basic science of public health Goals of Epidemiology Examples: Identify individuals at high risk for disease Recognize and control epidemics Monitor rates of disease and exposures in populations Types of Epidemiology Examples: Occupational Infectious Disease Cardiovascular Cancer Nutrition Environmental Injury Epidemiologic Studies of Naturally Occurring Phenomena Historical examples dating to 1747 Modern examples: Fluoride use and dental caries Cigarette use and lung cancer Tampon use and Toxic Shock Syndrome HPV exposure and cervical cancer Epidemiology in Health-Related Crime Investigations Examples: Deliberate poisoning Bioterrorism Need unlikely partners to work together Epidemiology can link disciplines Goal is to protect health of public Forensic Epidemiology Application of public health methods in a potential criminal investigation Litigation of health-related incidents Examples: silicone breast implants, E. coli infections, toxic shock syndrome, tobacco use Field-based investigations with law enforcement Example: intentional anthrax release in 2001 Epidemiology in the Courtroom Investigative experts Consulting experts Interview case-patients Understand scientific principles Understand statistical principles Testimony experts Present data Differences between Science and Law Science Ever-changing, open to peer review Disease in populations Evidence for association only Law Final Disease in individual Requires causal link Field-Based Forensic Epidemiology During the investigation Disciplines involved: Local and state health departments Police and firefighters State bureaus of investigation Emergency management services Hospitals and health clinics State laboratories Pharmacists Federal Bureau of Investigation National Guard and other military units Centers for Disease Control and Prevention Federal Emergency Management Administration United States Department of Agriculture Department of Homeland Security Attorney General’s Office Field-Based Forensic Epidemiology-Bioterrorism Two key groups: Public health and law enforcement Common goals: Protect the public Prevent/Stop the spread of disease Identify the responsible individual/party Safeguard those involved in investigation Field-Based Forensic Epidemiology-Bioterrorism Law enforcement contributions: Public health criminology expertise Forensic laboratory collaboration Law enforcement connections Public health contributions: Medical expertise Laboratory expertise Public health connections Examples of Confirmed Health-Related Criminal Cases Rabbit hemorrhagic disease virus; 1997 Shigella dysenteriae type 2; 1996 Bacillus anthracis, botulinum toxin, sarin; 1990-1995 Salmonella typhimurium; 1984 Ricin; 1978 Curacit; 1977-1980 Ascaris suum; 1970 Conclusion Forensic epidemiology has been used for many years; 2001 terrorist events have increased attention on field Public health and law enforcement can learn from each other Public health and law enforcement can successfully work together