Caregivers of Former WIC Children (Individuals/Households)

Site #

OMB Approval No. 0584-0580

Approval Expires: XX/XX/20XX

Appendix A1

Study extension consent age 6 – English

Feeding My Baby - A National WIC Study

Age 6 Study Extension Consent Form

Background

Westat, along with our partners at the Public Health Foundation WIC Program, the University of California Davis Nutrition Policy Institute, and Altarum Institute, is carrying out The Feeding My Baby Study for the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture. The study is being done to learn more about the choices WIC families make in feeding their children. FNS has extended the study to follow children enrolled in the study until the age of 6. We would like you to help by agreeing to participate in the study until your child is 6 years old, and allowing us to hear more about you, your family, and the choices you make in feeding your child.

What Would I Do in the Study?

Take Part in Telephone Interviews

If you agree to participate in the extension of this study, we will contact you when your child is 6 years old. The interview will ask you about your background, your household, your health and your child’s health, the choices you make about how and what to feed your child, your beliefs about feeding children, and your family’s and child’s behavior and eating habits. This final interview will take about 45 minutes.

Allow Us to Seek Information on Your Child’s Height and Weight

When your child turns 6, we will ask you either to return to a WIC office or to go to your child’s doctor to have your child weighed and measured.

What Are the Risks of Being In This Study?

We expect that your time in the study will be interesting and pleasant, and will not cause you discomfort. There is, however, a small risk to privacy since you are entrusting us with personal information. We will continue to take many steps and precautions to protect your privacy. Your name and your child’s name will not be used in any research reports. We will assign a study ID to your information, and only a small number of study staff will have access to the connection between study IDs and actual names. All study information will be stored on secure computer servers at Westat. We will not share personal information about you with WIC or with anyone else who is not on the study staff, unless otherwise required by law.

What Are the Benefits of Being In This Study?

There are no direct benefits or penalties to you for taking part in this study. The information collected during the study will help the FNS better understand how WIC mothers choose to feed their children, and how WIC services have helped mothers with those choices. They will then use this information to continue to improve WIC services for everyone.

As a token of our appreciation, we will provide you with a cash incentive of $60 for the 6 year-old interview (or $70 if using your own cell phone). We will provide you with a $70 incentive at age 6 for taking your child to a WIC office or your child’s doctor to be measured and returning the measurement card to us. Both incentives will be added to your prepaid MasterCard, so please hold on to your card.

What Are My Rights As a Participant In the Study?

Participation in this study is completely voluntary. Giving consent means that you have read the information and that you agree to take part in this study. If you do not want to answer a question during the interview, you may choose not to do so. If you decide to take part in the study and then change your mind, you can stop at any time. Again, there is no penalty to stop participating in the study or in parts of the study, and any WIC services or other benefits you receive will not be affected.

Who Should I Call if I Have Questions?

If you have questions about the study, a member of our study team can help you. For those questions, please contact [STUDY LIAISON] at [TOLL FREE NUMBER].

If you have a problem that the study team member couldn’t help you resolve, please call Dr. Nancy Weinfield at 1-800-937-8281, x2480.

If you have questions about your rights and welfare as a research participant, please call the Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your full name, the name of the research study that you are calling about (the Feeding My Baby Study), and a phone number beginning with the area code. Someone will return your call as soon as possible.

By signing below, I am saying that I have read the information presented here, and I agree to take part in the extension of the Feeding My Baby Study.

Signature

Date

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0584-0580.  The time required to complete this information collection is estimated to average 5 minutes (0.0833 hours) 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-0580).  Do not return the completed form to this address.