Youth Assent Form
Title of the Research Study:
The Impact of Television Viewing and Program Genres on Adolescent
- We are
inviting you to participate in this study because you are a teenager, and we
are interested in how different kinds of TV programs affect the way teenagers
do things. The study is conducted by the
Department of Communication at the University of Nebraska at Kearney
- If you
have any questions at any time, please ask.
research will take you about 30-45 minutes to do. First, we will train you on a computer
task. They you will watch a short
television program. This may be a comedy
show, or an instructional program, or a documentary program. Then you will do a task on the computer. The computer task involves choosing between
one of four part-time or summer jobs.
- Some of
the TV show you watch for the study may be a little boring, or they may make you
feel a little uncomfortable, just as watching tragic news events makes some viewers
feel uncomfortable. Being in the study will not have direct benefits to you,
but it may help researchers and teachers understand how teenagers make
choices. You also may learn something
about how to choose a part-time job.
However, if you agree to participate in this study you will not receive
a gift or money.
decision to be in this study is voluntary.
You do not have to participate if you do not want to. If you agree to participate in this study,
you can stop at any time without any consequences to you.
responses will be strictly confidential.
There will be no way for us to know which responses belong to you or to
someone else. We may publish a summary
of everybody’s responses or present a summary at a scientific meeting, but the
information will not identify you or your responses.
- We will
also ask your parents for their permission for you to be in this study. Please talk this over with them before you
decide whether or not to participate.
- If you
have questions or concerns about this study, contact Dr. Sally McIntire,
principal investigator, 306 Mitchell Center, University of Nebraska at Kearney,
Kearney, NE 68849, 308-865-9992. You
also may contact the University of Nebraska at Kearney Institutional Review
Board (IRB), 308-865-8886.
this form means that you have decided to participate and that all your
questions about the study have been answered. You and your parents will be
given a copy of this form to keep.
Name of Subject Date
of Subject Date
of Investigator Date
Identification of Investigators
Sally S. McIntire, Ph.D. University of Nebraska at Kearney
Office : 865-9992
Bobbie Sanchez, Ph.D. University of Nebraska at Kearney