CONSENT FORM AND SURVEY INTRODUCTION

Shauna Carlisle (PI), Associate Professor, School of Interdisciplinary Arts and Sciences, University of Washington Bothell.  ske9902@uw.edu, 425-352-3589.



RESEARCHER'S STATEMENT
My name is Shauna Carlisle and I am an Assistant Professor and researcher at the University of Washington Bothell.  As a second generation Canadian (born and raised) I am interested in understanding the role of stress on health.  I would like to invite you to complete an online survey on your social experiences and health while living in Canada.

I am going to give you information about this study and invite you to be a part of this research.  You do not have to decide to participate today but please read this form carefully.  This consent form will give you the information you will need to help you decide whether to be in the study or not.  You may ask questions about the purpose of the research, what we will ask you to do, the possible risks and benefits, your rights as a volunteer, and anything else about the research or this form that is not clear.  When we have answered all your questions, you can decide if you want to be in the study or not.

PURPOSE OF THE STUDY
You have been invited to complete an online survey on your health and social experiences with daily hassles while living in Canada.  We are interested in learning about the way in which daily hassles, especially those which may be because of your race or ethnicity, impact your health.  This study is important because it may provide health insights into what happens to the health of individuals the longer they are exposed to stress due to our race or ethnicity.  This study could help us understand why this happens so that we can develop ways of protecting our health in Canada.

STUDY PROCEDURES
We are asking you to complete an online survey that should take approximately 35 minutes to complete.  Your participation is voluntary and you are free to decline to answer any question you do not wish to answer.  This interview will ask questions about your experiences here in Canada and your self-reported health.  At the end of the survey you will be asked if you would like to be part of a follow up study.  You also have the option to be entered into a drawing for a $50 gift card for taking the time to complete this survey.  Information you provide for a follow up interview or for the gift card will be coded and your names and personal information will be removed from your responses and kept confidential.

RISK, STRESS, AND DISCOMFORT
No health-jeopardizing risks or stress will come out of your participation in this project.  You may feel a little sadness when asked to reflect on experiences with discrimination.  Participation is voluntary and you can ask questions about the research project at any time throughout the study.

BENEFITS
The study is not designed to benefit you but this research should help us learn how to improve the health and well-being of Caribbean, African, and African Canadian communities in Canada.

CONFIDENTIALITY
We intend to protect your privacy.  Your name and identifying information will not be used in any report that is published.  Your responses will be sent to a database managed by the University of Washington where the data will be stored in a password protected electronic format.  Only the research staff will review your responses.  Your name and personal information will be removed from your responses and replac

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