California American Indian Culture and Sovereignty Center
California State University San Marcos
Parent Consent for Child to Act as a Research Subject by Taking a Survey
California Student Tobacco Survey (CSTS)
California Indian Tobacco Youth Study (CAITYS) Project
Who is conducting the study, why your child been asked to participate, how your child was selected, and what is the approximate number of participants in the survey?
As part of a research project, Dr. Joely Proudfit, Chair of the American Indian Studies Department at California State University San Marcos (CSUSM) is conducting a survey for the University of California San Diego (UCSD) to find out more about the influence of newer tobacco products like e-cigarettes and hookah on student attitudes and use of these newer products and along with marijuana. Your child has been asked to take this survey because your child’s school has agreed to participate. Approximately 150,000 students from randomly selected California middle and high schools will participate in the survey this school year along with two private American Indian Schools, Noli Indian School and Sherman Indian High School.
Why is this study being done?
The purpose of this study is to provide CSUSM, UCSD and the larger tribal community with critical information necessary to guide ongoing strategic development for school and community interventions, which are part of the comprehensive tobacco control efforts in California. The California Department of Public Health is funding the study.
How much time will the survey take?
The online survey will take approximately 20 minutes.
What risks are associated with this survey?
There are no expected risks of physical, psychological, or social harm to your child.
What are the alternatives to participating in this survey?
The alternatives to participation in this survey are not to participate and to do an alternate activity assigned by the teacher while the survey is being given during school hours.
What benefits can be reasonably expected?
There may or may not be any direct benefit to your child from this survey. The investigator, however, may learn more about the risks facing youth related to tobacco use, including the use of newer products and other drugs. This will help improve programs to address these problems and provide better services for youth.
Can you choose to not to have your child participate or withdraw from the survey without penalty or loss of benefits?
Participation in the survey is entirely voluntary. You may refuse to allow your child to participate or withdraw your child at any time without penalty or loss of benefits to which you or your child. This research is not part of the child’s regular school program, is not being directly conducted by the school, and your child’s continued enrollment will not be affected by their decision to participate. If you decide you no longer wish your child to continue in this survey, your child will be requested to do an alternate activity assigned by the teacher while the survey is being given. You and your child will be told if any important new information is found from this survey that may affect your wanting to continue.
Can your child be withdrawn from the survey without your consent?
Your child may be withdrawn from the survey if you or your child do not follow the instructions given you or your child by the survey personnel.
Are there any costs associated with participating in this study?
There will be no cost to you or your child for participating in the survey.
What about your confidentiality?
Research records will be kept confidential and confidentiality will be protected by CSUMS and UCSD. No information will identify or connect your child with his/her answers so there is no risk of loss of confidentiality. All staff who give the survey will sign an assurance of confidentiality certificate.
Who can you call if you have questions?
By providing this form, Dr. Joely Proudfit and your child’s school and teacher have explained this study to you and answered your questions. If you have other questions or research-related problems, you may reach Dr. Proudfit at (760) 750 4619 or Dr. Deborah Morton at (760) 747 6634 and you may call the CSUSM Human Research Protections Program Office at (760) 750 4029 for more information or to inquire about your rights as a research subject or to report research-related problems.
Your Signature and Consent is needed if you DON’T want your child to participate. You have received a copy of this consent document to keep. If you don’t want your child to participate, please sign below and return this form to your child’s school.