Examining Knowledge of Oral Health by Formal Education Level and Minority Status

Researcher: Flor Porrata

Researcher’s Email Address: FPorrata1674@monroecollege.edu



You are invited to be part of a research study. The researcher is a Master of Public Health (MPH) student. The information in this form is provided to help you decide if you want to participate. The form describes what you will do during the study and the risks and benefits of the study.



If you have any questions or do not understand something in this form, you should ask the researcher with the information provided above. Do not continue unless the researcher has answered your questions and you decide that you want to be part of this study.



The researcher wants to examine knowledge of oral health by formal education level and minority status in adult’s ages 18 to 64 who reside in the Greater New York City area.



You are invited to be in the study because you are between the age of 18 to 64, residing in the Greater New York City area, and can read and understand the English language.



If you do not meet the description above, you are not able to be in the study.



If you decide to be in this study you will do the following things:Your participation in this study is voluntary. You can decide not to be in the study and you can change your mind about being in the study at any time. There will be no penalty to you. If you want to stop participating in the study, tell the researcher.



The researcher will keep the information you provide confidential. The researcher, researcher’s supervisor, and dissertation committee will have access to your study data. Additionally, Monroe College’s IRB, or its designees may review your research records.



Generally speaking, the researcher can assure you that he/she will keep everything you tell him/her or do for the study private. Yet there are times where the researcher cannot keep things private (confidential). The researcher cannot keep things private (confidential) when:



The researcher finds out that a child or vulnerable adult has been abused

The researcher finds out that that a person plans to hurt him or herself, such as commit suicide,

The researcher finds out that a person plans to hurt someone else

You can ask questions about the study at any time. You can call the researcher if you have any concerns or complaints. You should Email the researcher at the email address listed on page 1 of this form if you have questions about the study procedures or if you get hurt or sick during the study.



Monroe College’s Institutional Review Board (IRB) has been established to protect the rights and welfare of human research participants. Please contact them at 1-718-933-6700, extension 8392, for any of the following reasons:

You have questions about your rights as a research participant.

You wish to discuss problems or concerns.

You have suggestions to improve the participant experience.

You did not feel comfortable talking with the researcher.

You may contact the IRB without giving us your name. We may need to reveal information you provide in order to follow up if you report a problem or concern.



Additionally, please contact the MPH student Flor Aide Porrata, at the above mentioned contact information, if you have any other question(s) or concern(s) about this informed consent form which you need to have answered before signing it.



I have read this form, and I have been able to ask questions about this study. The researcher has spoken with me about this study. The researcher has answered all my questions. I voluntarily agree to be in this study. I agree to allow the use and sharing of my study-related records as described above.

OK