OMB No.: 0925-0645
Expiration Date: 12/31/2014
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0645). Do not return the completed form to this address.
Overview:
Today, you will be asked to participate in two research studies; each study is relatively short (adding up to a total of about 30 minutes for both studies), so we have combined them for convenience.
Why is this research being done?
In the first study, Self Study, we are interested in learning about people’s beliefs and values. In the second study, Cancer Risk Study, we are interested in learning about how people respond to information about cancer risk.
Who is being asked to take part in these research studies?
We are asking 500 individuals aged 40-70 who are overweight and who report having an opposite-sex close relationship with someone in that age group who is also overweight to participate.
What procedures will be performed for research purposes?
If you agree to be in these studies, you will be asked to do the following:
Self Study
1. Write a paragraph or two about a value that is important to you.
Cancer Risk Study
1. Read information about cancer risk.
2. Answer questions about the information you read and about your beliefs cancer risk.
The total time required to complete both of these studies should be approximately 30 minutes.
What are the benefits and risks to participation?
This study offers no direct benefits to participants. Participants will help contribute to the body of knowledge in social and health psychology. These studies do not include any medical procedures, and present minimal risk. Risks include any discomfort you may feel while reading about cancer risk.
Is participation voluntary?
Your participation in these studies is entirely voluntary and you may refuse to complete either study at any point, even after you give consent to participate, or refuse to answer any questions with which you are uncomfortable.
Who will know individuals who choose to participate in these research studies?
Your name and other identifying information will not be connected to your results or to your responses on the questionnaires. Information that would make it possible to identify you or any other participant will never be included in any report or publication of results. The data will be accessible only to those working on the project.
How will the information I provide be stored?
The anonymized data will be stored on a government server, which can only be accessed by the designated user (the Principal Investigator) and system administrators. No personally identifying data will be obtained or stored No human specimens will be collected or stored. Once the protocol is completed, the anonymized data will continue to be stored for potential secondary analyses.
Contacts and Questions:
If you have questions about the Values Study, you may contact Rebecca Ferrer at [email protected]. If you have questions about the Alcohol and Cancer Study, you may contact William Klein at [email protected].
Statement of Consent:
I have read the above information, and I understand that I am encouraged to contact the researchers listed if I have any questions about either study. I consent to participate in these studies.
Please click to continue to the studies. Clicking to continue indicates your consent to participate in these studies.
Thanks for your participation!
[Page for individuals in Self-affirmation conditions only]
In this study we are interested in investigating values. By values we mean the moral principles and standards by which people try to live their lives. For example, honesty might be a core value for some people. That is, they may try to be honest in all they do when dealing with other people.
Please look at the list of values below, and check the one that is most important to you.
Artistic skills
Athletics
Business/earning money
Compassion
Conscientiousness
Creativity
Friendliness
Generosity
Hedonism (the pursuit of pleasure/happiness)
Honesty
Independence
Intelligence
Kindness
Musical ability/appreciation
Politics
Relations with friends or family
Spirituality/Religiousness
Sense of Humor
Spontaneity/Living life in the moment
Trustworthiness
Other: (write in)________________________
Please type a short statement about why this value is important to you. Take a few minutes to think about this value and how this value has influenced your past behaviors or attitudes. Please write about how you use this value in your everyday life – at work, at home, with friends, or in dealing with strangers. If you can, try to recall and write about specific occasions on which this value determined what you did.
[Page for individuals in Non-affirmation condition only]
In this study we are interested in investigating values. By values we mean the moral principles and standards by which people try to live their lives. For example, honesty might be a core value for some people. That is, they may try to be honest in all they do when dealing with other people.
Please look at the list of values below, and check the one that is least important to you.
Artistic skills
Athletics
Business/earning money
Compassion
Conscientiousness
Creativity
Friendliness
Generosity
Hedonism (the pursuit of pleasure/happiness)
Honesty
Independence
Intelligence
Kindness
Musical ability/appreciation
Politics
Relations with friends or family
Spirituality/Religiousness
Sense of Humor
Spontaneity/Living life in the moment
Trustworthiness
Other: (write in)________________________
Please type a short statement about why this value could be important to another person. Take a few minutes to think about how this value may influence this person’s behaviors or attitudes. Please write about how this person may use this value in everyday life – at work, at home, with friends, or in dealing with strangers. Only think about why this value might be important to another person, and not why it is unimportant to you.
[Page for individuals in self-relevant cancer risk condition only]
When reading the following information about cancer risk, please think about how this relates to you.
[Page for individuals in other-relevant condition only]
When reading the following information about cancer risk, please think about how this relates to someone close to you (a family member, significant other, or close friend). Please think about someone specific, who is in the age range of 40-70, while reading the information.
[Page for women in self-relevant condition; men in other-relevant condition]
The following information is excerpted from the National Cancer Institute Breast Cancer Information Website (http://www.cancer.gov/cancertopics/types/breast)
Based on current breast cancer incidence rates, experts estimate that about one out of every eight women in the U.S. born today will be diagnosed with breast cancer at some time during her life.
Estimated new cases and deaths from breast cancer in the United States in 2013:
New cases: 232,340
Deaths: 39,620
Being overweight or obese can increase the risk of post-menopausal breast cancer. Other risk factors include age (a woman’s risk of developing breast cancer increases as she gets older), inherited changes in certain genes, and a personal or family history of breast cancer.
There are screening tests available to determine whether a woman is at increased risk for breast cancer. The effectiveness of these tests is variable, depending on age and other risk factors. For this reason, it is important that women engage in a conversation with their healthcare provider about their risk factors related to breast cancer, and to discuss whether a screening test is right for them.
[Page for men in self-relevant condition; women in other-relevant condition]
The following information is excerpted from the National Cancer Institute Prostate Cancer Information Website ( http://www.cancer.gov/cancertopics/types/prostate)
Based on current prostate cancer incidence rates, experts estimate that about one out of every five men in the U.S. born today will be diagnosed with prostate cancer at some time during his life.
Estimated new cases and deaths from prostate cancer in the United States in 2013:
New cases: 238,590
Deaths: 29,720
Being overweight or obese can increase the risk of prostate cancer. Other risk factors include age (a man’s risk of developing this disease increases as he gets older. Other factors can also increase a man’s risk of developing prostate cancer, including inherited changes in certain genes and a personal or family history of prostate cancer.
There are screening tests available to determine whether a man is at increased risk for prostate cancer. The effectiveness of these tests is variable, depending on age and other risk factors. For this reason, it is important that men engage in a conversation with their healthcare provider about their risk factors related to prostate cancer, and to discuss whether a screening test is right for them.
How much do you currently feel . . .
Stressed?
1 2 3 4 5 6 7
Not at all Extremely
Fearful or anxious?
1 2 3 4 5 6 7
Not at all Extremely
Happy or content?
1 2 3 4 5 6 7
Not at all Extremely
Angry or frustrated?
1 2 3 4 5 6 7
Not at all Extremely
Compassionate or nurturing?
1 2 3 4 5 6 7
Not at all Extremely
[Page for individuals in the self-relevant conditions only]
I intend to . . .
Lose weight in the next 6 months.
1 2 3 4 5 6 7
Definitely will not do Definitely will do
Talk to my provider about cancer in the next 6 months.
1 2 3 4 5 6 7
Definitely will not do Definitely will do
If you have any interest in losing weight, how will you go about it? Please list below any steps that you think you will take.
If you have any interest in talking to your provider, how will you go about it? Please list below any steps that you think you will take.
If your provider were to recommend that you get a test to see whether you are at increased risk for cancer, how likely would you be to have the test?
1 2 3 4 5 6 7
Definitely would do Definitely would do
How worried are you about getting cancer?
1 2 3 4 5 6 7
Not at all worried Extremely worried
How would you rate your chance of developing cancer in your lifetime?
1 2 3 4 5 6 7
Very low Very high
Overall, how do you think your chance of developing cancer compares to the average person your age and gender?
1 2 3 4 5 6 7
Much lower About the same Much higher
I feel very vulnerable to cancer.
1 2 3 4 5 6 7
Strongly disagree Strongly agree
How relevant did the cancer message seem to you?
1 2 3 4 5 6 7
Not at all relevant Very relevant
[Page for those in the other-relevant condition only]
I intend to encourage my close other to lose weight in the next 6 months.
1 2 3 4 5 6 7
Definitely will not do Definitely will do
I intend to encourage my close other to talk to his or her provider about cancer in the next 6 months.
1 2 3 4 5 6 7
Definitely will not do Definitely will do
If you have any interest in talking to your close other about losing weight, how will you go about it? Please list below any steps that you think you will take.
If you have any interest in encouraging your close other to talk to a provider, how will you go about it? Please list below any steps that you think you will take.
If your close other’s provider were to recommend that you get a test to see whether you at increased risk for, how likely would you be to have the test?
1 2 3 4 5 6 7
Definitely would do Definitely would do
How worried are you about your close other getting cancer?
1 2 3 4 5 6 7
Not at all worried Extremely worried
How would you rate your close other’s chance of developing cancer in his/ her lifetime?
1 2 3 4 5 6 7
Very low Very high
Overall, how do you think your close other’s chance of developing cancer compares to the average person of the same age and gender?
1 2 3 4 5 6 7
Much lower About the same Much higher
I feel my close other is very vulnerable to cancer.
1 2 3 4 5 6 7
Strongly disagree Strongly agree
How relevant did the cancer message seem to your close other?
1 2 3 4 5 6 7
Not at all relevant Very relevant
How interested are you in finding out more information about cancer?
1 2 3 4 5 6 7
Not at all interested Very interested
How likely is it that you will seek out additional information about cancer?
1 2 3 4 5 6 7
Not at all interested Very interested
How much did you believe the information presented in the website excerpt?
1 2 3 4 5 6 7
Not at all Very much
How much do you agree with the following statement: it seems like everything causes cancer?
1 2 3 4 5 6 7
Not at all Very much
| File Type | application/msword |
| Author | ferrerra |
| Last Modified By | Currie, Mikia (NIH/OD) [E] |
| File Modified | 2014-08-27 |
| File Created | 2014-08-27 |