Teachers College, Columbia University
New York, New York


Principal Investigator: Sheba King, MPH, CHES

Research Title: An online investigation of the role of gender and power dynamics in heterosexual relationships from the perspective of young African American women: Implications for the risk of HIV/AIDS.

• I have read and discussed the Research Description with the researcher. I have had the opportunity to ask questions about the purposes and procedures regarding this study.
• My participation in research is voluntary. I may refuse to participate or withdraw from participation at any time without jeopardy to future medical care, employment, student status or other entitlements.
• The researcher may withdraw me from the research at his/her professional discretion.
• If, during the course of the study, significant new information that has been developed becomes available which may relate to my willingness to continue to participate, the investigator will provide this information to me.
• Any information derived from the research project that personally identifies me will not be voluntarily released or disclosed without my separate consent, except as specifically required by law.
• If at any time I have any questions regarding the research or my participation, I can contact the investigator, who will answer my questions. The investigator's e-mail is sk3100@columbia.edu and her sponsor/supervisor (Dr. Barbara Wallace) can be contacted at bcw3@columbia.edu or 267-269-7411.
• If at any time I have comments, or concerns regarding the conduct of the research or questions about my rights as a research subject, I should contact the Teachers College, Columbia University Institutional Review Board /IRB. The phone number for the IRB is (212) 678-4105. Or, I can write to the IRB at Teachers College, Columbia University, 525 W. 120th Street, New York, NY, 10027, Box 151.
• I should receive a copy of the Research Description and this Participant's Rights document. (that I can print out)
• If video and/or audio taping is part of this research, I ( ) consent to be audio/video taped. I ( ) do NOT consent to being video/audio taped. The written, video and/or audio taped materials will be viewed only by the principal investigator and members of the research team.
• Written, video and/or audio taped materials ( ) may be viewed in an educational setting outside the research
( ) may NOT be viewed in an educational setting outside the research.
• My ELECTRONIC signature means that I agree to participate in this study.

Participant's ELECTRONIC assent:
Yes I reviewed my Participant's Rights.
Date: 06-25-2017

This ELECTRONIC assent keeps your identity confidential and anonymous, but allows you to proceed to the actual survey.


Institutional Review Board Protocol Approval # _12-080___

Sheba King, MPH, CHES, Doctoral Candidate, Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525 W. 120th Street, New York, NY 10027; sk3100@columbia.edu
Barbara C. Wallace, Ph.D., Director, Research Group on Disparities in Health and Global HELP-Health and Education Leadership Program, Professor of Health Education, Clinical Psychologist, Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525 W. 120th Street, New York, NY 10027; Bcw3@columbia.edu; Study Contact Number: 267-269-7411