GuLFOMBattachment3consentguide

National Institute of Environmental Health Sciences (NIEHS)

Appendix E:

GuLF Study - Post IRB
11/3/2010

Informed Consent Quick Reference Guide

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National Institute of Environmental Health Sciences (NIEHS)

GuLF Study - Post IRB
11/3/2010

Informed Consent Form for
Active Follow-up
Quick Reference Guide
Please read the Informed Consent Form before signing.
The GuLF Study is about the potential health effects of oil spill clean-up.
You already completed a survey about your experience in oil spill clean-up.
By joining the Active Follow-up part of the study, you are agreed to do the following:
During the in-home visit 1. Complete a 1-hour interview about your health, habits and other jobs
2. Allow an examiner to take your blood pressure, measure your height, weight, hips and
waist , and test your lung function (if eligible)
3. Provide blood, hair, toenail, urine, and possibly saliva samples
4. Allow our staff to collect dust from your home
Throughout the study 5. Update your contact information once a year
6. Complete a 30-minute telephone questionnaire every two years
7. Allow us to follow your health using state and national health records such as death
certificates or cancer registries
8. Allow us to contact you about related health studies
9. Allow us to share your coded data with other qualified researchers.
Length of Participation: The study will last at least 10 years. You may quit the study at any time.
Use of Information Collected: The information you shared will be used for research on the
potential health effects of clean-up activities related to the Deepwater Horizon oil spill in the Gulf
of Mexico. The consent form explains in more detail how we will use the information and samples
you gave for this study.
Results of Tests: You will be given information about your blood pressure, body mass index,
lung function, complete blood count (if measured), and urine glucose (sugar) level. At your
request, we will send any abnormal test results to your doctor or health clinic. We can refer you
to a health care provider in your area, if you want. We will send you regular reports that
summarize study findings. We can only share results of tests done in approved research labs.
Individual results of tests done in research labs will not be shared.
Benefits: You may benefit from getting the results of medical screening tests. These results will
let you know if you might benefit from seeing a doctor. We can help you find a doctor or clinic if
you do not have one. You will not receive other direct benefits. You may be proud to be part of a
research study that may help others.
Risks: Some of the questions we ask may make you uncomfortable. There is a small risk of
bruising or infection from the blood draw. The lung function test may cause coughing and a
feeling of lightheadedness. If this occurs, they will go away shortly after the test. There is also a
slight risk your private study information could become known to others. The consent form
explains what we will do to keep that from happening.
Confidentiality: Every effort will be made to protect the information and samples you provide.
The Gulf Study has a Certificate of Confidentiality that helps protect your information.

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National Institute of Environmental Health Sciences (NIEHS)

GuLF Study - Post IRB
11/3/2010

Costs: There are no costs to you other than your time.
Payment to Participants: If you complete the in-home visit, you will receive a $45 gift card You
may be eligible for other payments in the future.

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