Disclosure Statement

Salem State University
Institutional Review Board (IRB)
Disclosure Statement

My name is Kelvin Garcia. This questionnaire is for a research paper I am doing for school. It will ask you questions about the effects of Video Games on Academic performance, and relationships.

The procedure involves filling an online survey that will take approximately 10 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address. The SSL encryption is going to be will be on, and any downloaded data and files will be password protected. The survey questions will be about video game playing habits, past/current relationships and the impact on academic performance.


We will keep your information confidential. All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you. The results of this study will be used for scholarly purposes only and may be shared with Salem State University representatives.

Filling it out is completely voluntary. There are no right or wrong answers. You may stop at any time. All answers will remain completely anonymous. You do not have to answer any questions that make you feel uncomfortable. When you are done, please fold the questionnaire in half and return it to me.

The risks and benefits are due to the reflective nature of the questions that will be asked, there is a fair chance that some minor emotional discomfort may be stirred up, specifically speaking in regards to past and current relationships aspects. The potential benefit to the research participant as well as the society, include a better understanding of the dynamics of these three, and hopefully implement better strategies and attitudes that will maximize the virtues (Tenacity, Teamwork, Cooperation, Prosocial skills) that may be uncovered and minimize the vices (Competitive, Aggression).

An analysis of the results and an explanation of the study will be available in the Salem State University.

Understand that your name or identity will not be used in reports or presentations of the findings of this research. The information provided to the researchers will be kept confidential with the exception of information which must be reported under Massachusetts federal law such as cases of child or elder abuse.

This research project has been approved by the Institutional Review Board at Salem State University. Thank you for your help.

For questions or concerns about the research, please contact (Kelvin Garcia at Guardiankelvin@yahoo.com)


For concerns about your treatment as research participant, please contact:
Institutional Review Board (IRB)
Sponsored Programs and Research Administration
Salem State University
352 Lafayette Street
Salem, MA 01970
(978)542-7556 or (978)542-7177 or irb@salemstate.edu

This research project has been review by the Institutional Review Board at Salem State University in accordance with US Department of Health and Human Services Office of Human Research Protections 45 CFR part 46 and does not constitute approval by the host institution.
If you have any questions about the research study, please contact Kelvin Garcia at k_garcia4@salemstate.edu, and jtheriault@salemstate.edu.This research has been reviewed according to Salem State University IRB procedures for research involving human subjects.

* 1. Do you play any Games?

* 2. How old were you when you were first introduced to video games?

* 3. In the past 30 days, which of the following devices have you used to play video games? (Please select all that apply.)

* 4. In the past 7 days, roughly how many hours have you spent playing video games (e.g. gaming consoles, mobile phones, computers, etc.)?

* 5. Which do you prefer out of the following? 6 being the highest and 1 being the lowest?

* 6. How often do you play these video game genres?

  Never Rarely Sometimes Often Always
Music & Party
Role Playing
Survival Horror
Open World Sandbox

* 7. On a typical week, What time of day would you most likely play a video games the most?

* 8. How many Gamers of each gender are there in your household?

When playing Video Games...

* 9. Have you ever had a crush on a video game character? If so, who?

* 10. Do you feel fully engaged by the game? Do you feel a sense of “flow”?

* 11. Do you play with other family members at home?

* 12. Do you use online games to stay in touch with distant friends?

* 13. Do you feel more extroverted, or more likely to interact with others, when you play?

* 14. Do you feel a part of a larger community?

* 15. Do you contribute to that community – on forums, or wikis, or by making demo video or tutorials?

* 16. Are you proud of your accomplishments in this game?

* 17. Has the game made you more resilient?

* 18. How many people play video games in your household?

* 19. Are you currently in a romantic relationship?

* 20. Do you play games that involve establishing relationships? (Casual or Romantic)

* 21. What is your age?

* 22. What is your major?

* 23. How many hours per week do you spend studying? (During a typical week)

* 24. What is your ethnicity? (Please select all that apply.)

* 25. What is your current Grade Point Average(or Equivalent grading system?

* 26. What is your school year?

* 27. What is your gender?

100% of survey complete.