Middle School Digital Nutrition (SLT)

OMB Control # 0584-0524

Expiration Date: 6/30/2016

Attachment A – Teacher Email, Teacher Informed Consent Form, Questionnaire for Participation in Focus Groups (Consent Package for Teacher Focus Groups)

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated as part of the 15 minutes for the screener, including the time for reviewing instructions and completing the information.

[DATE], 2016

Dear Teacher,

My name is [Researcher’s Name] and I work for the Michael Cohen Group, a research firm that specializes in children, education and media.

We are currently looking for teachers at your school to discuss activities and materials they enjoy teaching and that are engaging and effective for students. The United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) is sponsoring this effort in order to help develop new curricula and materials that will eventually be available to all teachers at no cost.

Specifically, the lessons will raise awareness of the importance of healthy food choices and physical activity among middle school children. The curriculum will include informational texts, interactive applications, and videos. It is important for us to get teacher feedback about these materials so the final products are relevant, meaningful, and fun.

To this end, we are looking for teachers of all subjects to participate in a 45-minute focus group at your school, either before school, during lunch, or after school, depending on your availability. A hot meal will be provided to all teachers that volunteer to participate, and your school will be provided with a $250 facilities fee for hosting this research.

Last, we would like your help distributing consent forms to the parents of your students so that we can conduct focus group interviews with students in your school.

If you would like to participate in the focus group and help distribute parent consent forms, please click [insert link to consent form and survey] to fill out a brief survey and consent form, or contact [insert designated coordinator].

Thank you for your consideration and we look forward to working with you.

Sincerely,

[Researcher]

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated as part of the 15 minutes for the screener, including the time for reviewing instructions and completing the information.

Teacher Informed Consent Form for Focus Group Participation

STUDY TITLE: USDA FNS Digital Nutrition Education Materials for Middle School Students and Teachers

PROTOCOL NUMBER: XXXX

PRINCIPAL INVESTIGATOR:	Gerad O’Shea
TELEPHONE:	212-431-2252
ADDRESS:	Michael Cohen Group LLC 375 West Broadway, Suite 502 New York, NY 10012

BACKGROUND AND PURPOSE:

You are invited to participate in a research study conducted by the Michael Cohen Group (MCG) as part of a United States Department of Agriculture Food and Nutrition Service sponsored effort to develop a curriculum that will raise awareness of the importance of healthy food choices and physical activity among middle-school children. Michael Cohen Group is an international research firm that specializes in children, education, and media.

We are working to help develop nutrition lessons that include informational texts, interactive applications, and videos that promote healthy food choices and physical activity. If you choose to participate, you will discuss the activities and materials you enjoy teaching and that you find engaging and effective for students. You will also be asked to brainstorm potential new content. The United States Department of Agriculture is sponsoring this effort in order to help develop new curricula and materials that will eventually be available to all teachers at no cost.

PROCEDURES:

You will be asked to participate in a focus group interview in which you will discuss the activities and materials that you enjoy teaching and that you find engaging and effective for student learning. You will also be asked to brainstorm potential content areas that could be integrated into your lesson plans, as well as materials and activities that you would suggest including. The interview will be done in a group setting with other teachers from your school. The interview will last about 45 minutes and will take place at your school at a time that is convenient for you. About 48 teachers will participate in total across the country, about 4 per group. The interview will be audio-recorded for research purposes only.

Further, you will be asked to distribute and collect parental consent forms from the students in your class. These forms will be used to recruit and invite students to participate in focus groups in which they will share their opinions about the materials being developed.

POSSIBLE RISKS AND BENEFITS:

We do not anticipate any risks associated with being in this study. We do not promise that you will receive any benefits from this study. However, we do anticipate that most people will enjoy participating in the research process and the research will lead to the development of free teacher resources that will be developed by the USDA.

COMPENTSATION:

You will not receive monetary compensation for your participation, but you will be provided with a hot meal at the time of the focus group.

PARTICIPANTS’ RIGHTS:

Participation in this study is voluntary. We will not work with you unless you give your consent. You have the right to change your mind and withdraw your consent or discontinue participation at any time without any penalty or loss of the benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions.

Your name, addresses, and phone numbers will only be used to contact you about this research activity. They will not be given to anyone else for other purposes. The research may be audiotaped for research purposes only. Your name will never be used in any reports of our research findings. Your information will be kept secure and only used for research purposes, except as otherwise required by law. All data will be identified only by an ID number, not by any name.

CONTACT INFORMATION:

Questions, Concerns, or Complaints: If you have any questions, concerns or complaints about this research study, its procedures, risks and benefits, please contact the Principal Investigator, at the telephone number listed on the first page of this form.

If you have any questions or complaints about your rights as a research subject, contact:

• Mail:

Study Subject Adviser

Chesapeake Research Review, Inc.

7063 Columbia Gateway Drive, Suite 110

Columbia, MD 21046

• Call collect: 410-884-2900

• Email: [email protected]

Teacher Informed Consent Form

Please complete the sections below if you agree to participate. A copy of this form will be emailed to you for your records.

I, _____________________________________, agree to participate in this research

[your name]

project with the Michael Cohen Group. I understand that I may stop participation at any time.

_______________________________________________ _________________

Signature Date

____________________________________________

Phone (for research purposes only)

____________________________________________

Email Address (for research purposes only)

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523. The time to complete this information collection is estimated as part of the 15 minutes for the screener, including the time for reviewing instructions and completing the information.

Questionnaire for Participation in Focus Groups

Please choose the option that best answers each question for you.

1. What grade(s) do you teach (please check at that apply)?

( ) 4^th Grade ( ) 7^th Grade

( ) 5^th Grade ( ) 8^th Grade

( ) 6^th Grade ( ) 9^th Grade

2. What subject(s) do you teach (please check at that apply)?

( ) English Language Arts ( ) Psychical Education

( ) Math ( ) Health

( ) Science ( ) Professional Studies

( ) Nutrition ( ) Technology

( ) History ( ) Arts or Music

( ) Social Studies ( ) Foreign Language Studies

( ) Other__________

3. How many years have you been teaching?

( ) First year

( ) 2-5 years

( ) 6-10 years

( ) 11-15 years

( ) Over 15 Years

4. Ethnicity

( ) Hispanic or Latino ( ) Not Hispanic or Latino

5. Race (select one or more)

( ) American Indian or Alaskan Native

( ) Asian

( ) Black or African American

( ) Native Hawaiian or Other Pacific Islander

( ) White

6. What is your current age?

( ) Under 25

( ) 25-34

( ) 35-44

( ) 45-54

( ) 55+

7. What is your gender?

( ) Female ( ) Male