Informed Consent ~ Adult Community Survey

 

WHAT IS THE REASON FOR THIS SURVEY?
Your community has received funding from the State of Alaska to help prevent the abuse of alcohol among adults. In order to assess what strategies would be most effective, it is important to find out what the typical levels of drinking are in your community, what specific attitudes and perceptions people have related to alcohol use, and whether people in your community participate in risky alcohol related behaviors. This survey will also help to assess whether the prevention efforts are working and how your community and the State of Alaska can improve those efforts.

IS THERE ANY COMPENSATION?
There will be no monetary compensation for participating in this survey.

WHO CAN PARTICIPATE?
You are invited to participate if you are at least 21 years old.

WHAT WILL I BE ASKED TO DO?
Those who choose to participate will complete a survey, which will ask questions regarding your personal use of alcohol and your opinions regarding alcohol use by others in your community. The survey will take approximately 10 minutes to complete.

WHAT ARE THE POTENTIAL BENEFITS AND RISKS?
Your participation in this survey only takes some of your time. There are no personal benefits; however, your willingness to share your experiences and opinions will help provide valuable information to the ongoing prevention efforts in your community. There are no significant risks, though there may be some discomfort with the content of certain questions.

WHAT ABOUT CONFIDENTIALITY?
We will keep all of your answers completely private and confidential. We will not share your answers with anyone other than those involved in evaluating the efforts occurring in your community to prevent alcohol abuse. Your name or other identifying information will not be included in the database that includes responses to this survey. Individual responses will not be associated with your name or other identifying information in any reports of results. We will report about the survey only with group averages and without revealing individual answers to anyone.

WHAT IF YOU DON’T WANT TO TAKE THE SURVEY?
Your participation is completely voluntary. You may stop at any time and you do not have to answer any questions you don’t want to. Nothing will happen to you if you choose not to answer any questions or if you decide not to participate.

WHAT IF I HAVE QUESTIONS?
If you have questions or concerns about this study, please contact Desiré Shepler, Community Evaluator (907-874-2373) or Kimberly Kilkenny, Project Director (907-772-3332). If you have any questions about your rights as a research subject, please contact Terry Powell, Administrator for the Alaska Area Institutional Review Board, at 907-729-3924.

Please ask if you would like a copy of this consent form for you to keep.

Question Title

* 1. Completing and submitting this survey indicates that you have read and understood the information above and agree to participate in this study.

If you would like to participate, please click the ‘Accept’ button below. If not, please click ‘Decline.’

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