Consent for Participation

Please read the consent carefully. After doing so please indicate whether you agree to participate or do not agree to participate by selecting either YES or NO, respectively.

* 1. Study Title: “Eating in Pregnancy: A Validation”

This study entitled “Eating in Pregnancy: A Validation” is interested in your eating behaviors while being pregnant and is being conducted by Natalia Orloff, a graduate student in the Psychology Department at the University at Albany. The information you provide will be used for research purposes. We will ask you about your pregnancy history, including history about your weight gain/loss during prior pregnancy and questions about what you believe to be true regarding pregnancy. Further, information about your cravings, food choices, and eating behaviors during pregnancy will be asked.

Completion of the questionnaire should take no more than 15 minutes. This questionnaire is anonymous. You will not be asked to indicate any information that would enable us to link your responses to your identity.

Benefits to participating in the current study include an opportunity to reflect on your own behaviors as they relate to your health and wellbeing. Possible benefits to others include a better understanding of food intake and weight-related health in pregnancy, which may ultimately lead to the development of interventions targeting eating behaviors in pregnancy.
We do not anticipate any risk in your participation other than you may become uncomfortable answering some of the questions. You can skip any question that you are uncomfortable answering without any adverse consequences regarding your participation in the study.

Your participation in this study is completely voluntary. Even after you agree to participate in the research, you may decide to leave the study at any time without penalty or loss of benefits to which you may otherwise have been entitled. You may choose not to answer any questions and may refuse to complete any portions of the research you do not wish to for any reason. Information obtained in this study is strictly confidential unless disclosure is required by law. In addition, the Institutional Review Board and the University or government officials responsible for monitoring this study may inspect these records.

If you have any questions about this study or your role in participation you may contact the PI or the faculty advisor (contact information located in this document). In addition, if you find you are having concerns about your eating habits we encourage you to contact your physician and/or OBGYN.

Questions? Please contact the principal investigator of the study, Natalia C. Orloff, M.S., M.A. (Tel: 484-321-1124; Email: or the faculty advisor, Julia M. Hormes, PhD. (Tel: 518-442-4911; Email: 

IRB contact about your rights in the study or to report a complaint:
Research at the University Albany involving human participants is carried out under the oversight of the Institutional Review Board (IRB). This research has been reviewed and approved by the IRB. If you have any questions concerning your rights as a research subject or if you wish to report any concerns about the study, you may contact University at Albany Office for Pre-Award and Compliance Services at 1-866-857-5459 or

Clicking "YES, I agree to participate in the survey" below indicates that you understand the purpose of the study and your consent to participate. Conversely, if you choose "NO, I do not agree to participate in the survey," you will be finished with the questionnaire.

Please print a copy of this consent for your records.

Thank you!