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Firsthand and Secondhand Smoke Exposed Depression and Anxiety Rates

1.Why am I being asked?
You are being asked to be a participant in a research study about depression and anxiety prevalence among individuals who have been exposed to secondhand smoke compared to individuals who have smoked tobacco firsthand for at least five years conducted by Molly Lynn Henson at Purdue University Global. You have been asked to participate in the research because you have either been exposed to secondhand tobacco smoke for at least five years or smoked tobacco for at least five years and may be eligible to participate. We ask that you read this form and ask any questions you may have before agreeing to be in the research.

Your participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relations with Purdue University Global. If you decide to participate, you are free to withdraw at any time without affecting that relationship.

What is the purpose of this research?
Examine the depression and anxiety prevalence among firsthand smokers compared to individuals who have been exposed to secondhand tobacco smoke.

What procedures are involved?
If you agree to be in this research, we would ask you to do the following things:
Complete the survey provided to the best of your abilities and remain honest with your answers.

What are the potential risks and discomforts?
The research may cause you to reflect on depression and anxiety symptoms. Questions related to symptoms of mental health and is not for diagnostic purposes.

Are there benefits to taking part in the research?
This study will provide information about the mental health effects firsthand smoking and secondhand smoke causes either in the long-term or short-term. Results from this study could be used to inform the science community and public of the dangers of smoking tobacco and being around tobacco.

What about privacy and confidentiality?
The only people who will know that you are a research subject are members of the research team. No information about you or provided by you during the research will be disclosed to others without your written permission. When the results of the research are published or discussed at conferences, no information will be included that would reveal your identity.

Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law.
· Before the survey is conducted, there will be a prompt for you (participant) to create your own personal identifier (A list of numbers or letters) that does not include your identity.
· Informed consent will be provided and obtained before the survey is given/completed.
· Responses to the survey will be analyzed then deleted after five years using the current Department of Defense data destruction standards.

Will I be reimbursed for any of my expenses or paid for my participation in this research?
· Participants will not be reimbursed or receive academic consequences for participation in the study.

Can I withdraw from the study?
You can choose whether to be in this study or not. If you volunteer to be in this study, you may withdraw at any time without consequences of any kind. You may also refuse to answer any questions you don’t want to answer and still remain in the study.

Who should I contact if I have questions?
The researcher conducting this study is Molly Lynn Henson. You may ask any questions you have now. If you have questions later, you may contact the researchers at: Phone: (817) 676 5181.
2.What are my rights as a research subject?
If you feel you have not been treated according to the descriptions in this form, or you have any questions about your rights as a research subject, you may contact the Institutional Review Board (IRB) at Purdue University Global by emailing the IRB chairperson at:
Email: pgirb@purdueglobal.edu

Remember: Your participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relations with the University If you decide to participate, you are free to withdraw at any time without affecting that relationship.
3.Please create your own personal code using a random list of numbers and/or letters. This code will be used for data analysis ONLY and will NOT be published.
4.Have you smoked tobacco at any point in your life for at least 5 years consecutively?
5.Have you been at any point in your life exposed to secondhand smoke for at least 5 years consecutively, either in the home or at work?
6.Have you received a depression and/or anxiety diagnosis before smoking or being exposed to tobacco smoke?
7.Are you currently taking prescription medications for depression and/or anxiety?
8.Over the last two weeks, have you felt nervous, anxious, or on edge?
9.Over the last two weeks, how often have you been bothered by not being able to stop or control worrying?
10.Over the past two weeks, have you had little interest or pleasure in doing things?
11.Over the past two weeks, have you been feeling down, depressed, or hopeless?
12.How old are you?
13.Are you 18 years old or older?
14.How do you identify your gender?
15.What is the highest level of education you have completed?
Thank you so much! If you have friends you think could complete this survey, please share!

Redeem the following Survey Code at https://www.surveycircle.com and get free survey participants through SurveyCircle. The Survey Code is: YH64-2HQK-9PLN-HDQJ
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