CONSENT FOR PARTICIPATION IN A RESEARCH PROJECT 200 FR. 1 (2014-3)
YALE UNIVERSITY SCHOOL OF MEDICINE
Study Title: Associations among Parenting Practices, Parent Eating Behavior, and Child Overweight
Principal Investigator: Janet A. Lydecker, Ph.D. (email@example.com)
Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Invitation to Participate and Description of Project
You are invited to participate in a research study designed to describe how parenting practices and parent eating pathology relate to child overweight, eating behaviors and body image. You have been asked to participate because you have a child between the ages of 6 and 15 years old for whom you are the parent or primary caregiver (the child lives with you more than half the time). We know that parents play an important role in their children’s eating behaviors and weight, but we do not know the nature of parenting practices around eating behaviors. We expect up to 3000 parents to participate in this study.
Description of Procedures
If you agree to participate in this study, you will be asked to complete online surveys once. This is expected to take 30-60 minutes. These surveys will ask you questions about yourself, parenting, and your child. Questions will be about health, mood, and attitudes about eating and weight.
Risks and Inconveniences
There is the possibility that some of the questions during the interviews or in the questionnaires may make you mildly uncomfortable. You may choose to skip any question by selecting the “I choose not to respond to this question” option.
There may be no direct benefit to you from your participation in this study. It is anticipated that some of the knowledge obtained in this study can be used to improve prevention and treatment of children’s health.
There will be no costs to you for participating in this study. You will not be compensated for your participation.
We will not collect any identifiable information in connection with this study. When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity unless your specific consent for this activity is obtained.
Representatives from the Yale Human Research Protection Program, the Yale Human Investigation Committee (the committee that reviews, approves, and monitors research on human subjects) may inspect study records during internal auditing procedures. However, these individuals are required to keep all information confidential.
Voluntary Participation and Withdrawal
Participating in this study is voluntary. You are free to choose not to take part in this study. Refusing to participate will involve no penalty or loss of benefits to which you are otherwise entitled (such as your health care outside the study, the payment for your health care, and your health care benefits). You are free to stop and withdraw from this study at any time during its course.
You do not give up any of your legal rights by agreeing to participate in this study.
We have used some technical terms in this form. Please feel free to ask the principal investigator [Janet A. Lydecker, Ph.D. (firstname.lastname@example.org)] about anything you don't understand and to consider this research and the consent form carefully – as long as you feel is necessary – before you make a decision.
I have read this form and have decided to participate in the project described above. Its general purposes, the particulars of my involvement and possible hazards and inconveniences have been explained to my satisfaction.
By selecting these boxes, I confirm that: