You are invited to take part in a
research study. Please take as much time as you need to read this consent form.
You are welcome to discuss it with others. Please read the information below,
and ask questions about anything you do not understand before deciding whether
or not to participate. If you decide to participate, you will be check a box
saying that you agree to participate.
IS THIS STUDY BEING DONE?
This is a study to learn about the awareness and behaviors of students at member universities of the Association of Pacific Rim Universities (APRU) regarding tobacco products, including e-cigarettes. APRU is a network of 45 universities in the Pacific Rim, representing 16 economies, 120,000 faculty and more than 2 million students. The APRU Global Health Program is hosted by the University of Southern California’s Institute for Global Health. The members are an inter-disciplinary group of faculty and students from universities around the Pacific Rim who are interested in global health. Your university is a member of APRU.
This is a study to learn about the perceptions and experiences of students in the Pacific Rim with regard to tobacco and e-cigarettes. We will ask you about your history of smoking and e-cigarette use, and about your current health. We’re hoping you will be interested in participating in this online survey. You are being invited to participate because you are a student at a member of the Association of Pacific Rim Universities.
What is involved in the study?
If you decide to participate in this study, we would ask you to complete
a 15-minute written online survey today. This survey will be used for research
regarding the perceptions and behaviors regarding tobacco and e-cigarettes
among students in the Pacific Rim.
WHAT ARE THE POSSIBLE RISKS AND DISCOMFORTS?
You may find answering questions about tobacco, e-cigarettes or your
health to be uncomfortable. If any of
the questions make you uncomfortable, you can skip them. You can stop the
survey at any time.
WILL YOUR INFORMATION BE KEPT PRIVATE?
We will keep your
records for this study confidential as far as permitted by law. However, if we
are required to do so by law, we will disclose confidential information about
you. The University of Southern California’s Institutional Review Board
(IRB) may review your records. The IRB is a research review board that is made
up of professionals and community members who review and monitor research
studies to protect the rights and welfare of research participants. We may publish
the information from this study in journals or present it at meetings. All of the data collected in this study will be destroyed at the end of
There is a small risk that
people not connected with this study will learn your identity or personal
information. However, every attempt is made to keep all your information
strictly confidential. It is kept on a secure password protected computer
database. No one else except USC researchers will be allowed to see your
answers. We will not share information with your university, employer, friends,
WHAT ARE THE POSSIBLE BENEFITS OF TAKING PART IN THIS STUDY?
Participation is voluntary. There are no costs associated with participating. You can choose not to participate in this survey. You will not receive any direct benefit from taking part in this study, but your participation may help us understand smoking among students. You will receive not receive any compensation for your time for
completing the survey. If you choose not to participate, that will not affect your relationship with APRU or your university. You are not giving up any legal claims or rights. If you decide to participate, you are free to change your mind and stop being in the study at any time.
WHOM DO YOU CALL WITH
QUESTIONS OR CONCERNS?
You may contact Mellissa Withers at +1-323-865-0495 with any questions,
concerns, or complaints about the research or your participation in this study.
If you feel you have been hurt by taking part in this study, please contact
Mellissa Withers. If you have questions, concerns, or complaints about the
research and are unable to contact the research team, contact the Institutional
Review Board (IRB) Office at +1-323-223-2340 between the hours of 8:00 AM and
4:00 PM, Monday to Friday. (Fax: +1-323-224-8389 or email at firstname.lastname@example.org).
If you have any questions about your rights as a research participant,
or want to talk to someone independent of the research team, you may contact
the Institutional Review Board Office at the numbers above or write to the
Health Sciences Institutional Review Board at LAC+USC Medical Center, General
Hospital Suite 4700, 1200 North State Street, Los Angeles, CA 90033.