Form 1 Parent Consent Form Survey Fact Sheet

Attachment 6

Parental Consent Form – Survey Fact Sheet

Evaluation of Transmissible Risk for Substance use Disorder in Youth STUDY – FACT SHEET

Why is the study being done?

The study aims to validate a questionnaire that was developed to measure behavioral characteristics in teens and young adults that have been found to be associated with future substance use problems. In order to validate a questionnaire it is necessary to know that it actually measures what it is supposed to be measuring. To do this requires a comparison of a person’s performance on these questions with other questions known to measure these behavior traits and assess whether the questions can discriminate between young people who have the traits and those who do not. The study is supported by the National Institutes of Health (NIH), funding number HHSN271201100016C.

What are the possible benefits from taking part in this study?

Your children will receive no direct benefit at this time by taking part in this research project; however the school will receive $500 for their participation. The information gained from this research study is intended to assure that the instrument developed is measuring the behavioral traits it is designed to measure. With this assurance, doctors and other health professionals will be able to use this instrument to assess risk for future substance use problems in young people.

How many schools and students are asked to participate?

Approximately 36 public and private high schools around the nation have been selected for inclusion in the Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation Study. Within each of these schools, about four to eight classes (130 to 160 students) in grades 9 through 12 will be selected by random sample to actually complete the survey. The use of random sampling can minimize the number of schools and the number of students that participate. Thus, your participation is imperative for successfully obtaining this important information on student health issues.

When is the study conducted?

Students will complete the survey at some point between October 2014 and May 2015, on a day selected by the school.

How is the survey handled in each school?

A staff member at the school (e.g. assistant principal, nurse, counselor or teacher designated by the principal) serves as liaison for the survey. The liaison provides a list of class sections (so that a sample can be selected), assists with parental notification and promotes the survey in the school. The Bloustein Center for Survey Research (BCSR) provides all the materials and its trained staff will facilitate the online administration of the survey to selected classes on a day of the school’s choosing.

How do students complete the survey?

All data collection will be conducted electronically, using easily accessible web and computer-based interfaces. Schools will be supplied with a URL for the web interface and will be given unique passcodes to guarantee designated access to the site, on a day of the school’s choosing.

How long does it take to fill out the survey? Is there any physical test involved?

The survey takes no more than 40 minutes to complete, or about one class period. The survey contains about 170 brief questions. No physical test or exam is involved.

Are sensitive questions asked?

Some school personnel, parents or students may consider some questions on the survey to be sensitive. For instance, the survey includes questions on theft, physical violence, and whether a student’s friends use tobacco, alcohol and other drugs, or carry weapons.

How is student privacy protected?

Your child’s identity and involvement in this research study is completely anonymous. Your child’s name will never be collected during the course of this study and no information collected during the course of the study will be able to identify your child. Any information obtained from this research will be accessed only by research team members. Your children’s identity in this study will be indicated by a case number rather than by their name.

In addition, any use of the findings will not identify any participating schools or students. Only aggregate level data will be provided. Therefore, both school and student participation is considered anonymous.

The survey procedures have been carefully reviewed by the Rutgers University Institutional Review Board to ensure that they provide for student privacy and voluntary informed consent.

Do students answer questions truthfully?

Research indicates that data of this nature gathered from adolescents have the same reliability as data gathered from adults. Among both adolescents and adults, a few may over-respond and a few may under-respond. Internal reliability checks help to identify the small percentage who falsifies their answers. To obtain truthful answers, students must perceive that the survey is important and be certain that procedures are implemented to protect their privacy and assure their anonymous participation.

Is the survey voluntary?

Yes. Participation is voluntary for schools and students. However, to obtain accurate nationwide data, participation rates must be high. Selected students cannot be replaced. The goal is to achieve 90 to 95 percent participation by selected schools and students.

Where can I get more information?

The Bloustein Center for Survey Research,

Siobhan Foley at 848-932-2782. Rutgers University, Office of Research and Sponsored Programs, Institutional Review Board, Sponsored Programs Administrator at

848-932-0150.

The Evaluation of Transmissible Risk for Substance Use Disorder in Youth Study

Dear Parent or Guardian:

Your child’s class in school is taking part in the Evaluation of Transmissible Risk for Substance Use Disorder in Youth Study. The study is being administered by the Bloustein Center for Survey Research at Rutgers University and it is funded by The National Institutes of Health [NIH funding number HHSN271201100016C]. Students in several classes will be asked to complete a survey which takes no more than 40 minutes to complete. The survey contains about 170 brief multiple choice questions concerning relationships in the home, physical fighting, carrying weapons and tobacco, drug or alcohol use.

Please check and sign this form, giving your written consent for your child to participate or your written refusal. Please return the signed form in either case.

Your child’s standing at the school will not be affected regardless of whether you check the YES or NO box on the form. The Bloustein Center will award the school $500 for participation

This study is being conducted in order to validate a questionnaire that was developed to measure behavioral characteristics in teens and young adults found to be associated with future substance use problems. The findings will help doctors and other health professionals with efforts to identify at-risk youths for the purposes of early intervention.

Students will not put their names on the survey. No school staff or student will handle the completed survey information at any time. No school or student will be mentioned by name in a report of the results. There is no way to trace any survey to an individual so no one will know that your child has participated.

It is possible that some students might find certain questions to be sensitive or embarrassing. Some questions on the survey may be considered sensitive by some school personnel, parents or students. For instance, the survey includes questions on theft, physical violence, and whether a student’s friends use tobacco, alcohol and other drugs, or carry weapons. These questions may be considered sensitive topics. There are also some items regarding parental relationships at home. Students can skip any question that they do not wish to answer. In addition, students can stop participating in the survey at any point.

It is important that all selected students take part in the survey. But the survey is voluntary. No action will be taken against the school, you, or your child if your child does not participate.

You can review a copy of the survey by contacting the principal’s office of your child’s school. If the school principal cannot answer your questions about the survey or about your child’s rights when participating, please call the Rutgers University Sponsored Programs Administrator at 848-932-0150. You may also contact Siobhan Foley from Bloustein Center for Survey Research at 848-932-2782.

The Evaluation of Transmissible Risk for Substance Use Disorder in Youth Study

Please check ONE response below and write your child’s name and grade, the date, and your signature. Have your child return the form to their teacher right away, regardless of whether or not you allow your child to participate.

[ ] YES, my child may participate in this survey [ ] NO, my child may not participate in this survey

Student Name:___________________________________________________ Grade:_______________

Parent/Guardian Signature:_________________________________________ Date:________________