Thomas Detre Hall
3811 O’Hara Street
Pittsburgh, PA 15213-2593
CONSENT TO PARTICIPATE IN SCREENING SURVEY
STUDY NAME: Social Jet Lag in Teens and Delayed Sleep Phase in Teens Research Studies
PRINICIPAL INVESTIGATOR:
Brant P. Hasler, PhD
Assistant Professor
Telephone: 412-586-9209
STUDY COORDINATOR:
Kathryn Guo, BA
Email: guok@upmc.edu
Phone: 412-246-6422
SOURCE OF SUPPORT:
National Institutes of Health

  • This is a screening for two studies aimed at learning more about how changes in sleep affect teens’ mood and behavior. It’s for 11th or 12th grade students between the ages of 16 and 19 years old.
  • Initial screeningThis survey will tell us if you are eligible to participate for one of the studies. You can complete survey questions on the website, or if you prefer, over the telephone (call 412.246.6422). It will take about 5-10 minutes. Please do the questions yourself. The survey questions ask about you, your sleep, health, and drug and alcohol use.
  • You will not directly benefit from this survey; however, one of every 25 teens who complete the survey will earn $50.
  • If you are eligible for one of the full studies and participate, you will be compensated. You will be compensated $455 or more, although this will depend in part on which research study you are eligible for, which group you are assigned to, and how many visits you complete.
  • There is a risk of breach of confidentiality—people outside of the study team may learn of your participation in the survey and/or get access to your screening data.
  • Researchers will discuss your participation with other members of the research team only. The research staff will keep all information from this research as confidential (private) as possible. We cannot ensure that the people around the teen while they are completing the survey, including parent(s), would not have access the information. The University of Pittsburgh requires that all research records be kept for at least seven years after the study ends. All database records related to your involvement in this research study will be stored with password protection.
  • Your identity on these records will be indicated by a case number rather than by your name, and the information linking these case numbers with your identity will be kept separate from the research records. The information obtained in this study may be published in medical journals, but your identity will not be revealed.
  • Your participation in this study is completely voluntary.This consent is for the online screening only. You may refuse to take part in it, and you withdraw participation at any time, even after indicating assent (agreement) below.

    Please also note that your written consent will be required for the main study, if you appear eligible based on this initial screening You will receive more information about the study at an in-person interview, and you are not obligated to participate.
    If you have any further questions about this research study, you may contact the investigators listed at the top of this page. If you have any questions about your rights as a research participant, please contact the Human Subjects Protection Advocate at the University of Pittsburgh IRB Office (1-866-212-2668).

PARTICIPANT’S CERTIFICATION
  • I have read the consent form for this screening survey. A copy of this consent form will be provided to me via email if I so request.
  • I understand that I am encouraged to ask questions about any aspect of the research study, and that those questions will be answered by the researchers listed at the top of this page.
  • I understand that my participation in this screening is voluntary and that I am free to refuse to participate or to withdraw consent and discontinue participation in this screening and subsequent research study at any time without affecting my future relationship with this institution.
  • I agree to participate in this screening survey.