The Justice Study
Interactions with law enforcement can affect our daily lives. The questions in this survey will be asking about experiences you, your friends, family, or other people in your community may have had with law enforcement officers. These questions aim to gather general information about the health impacts of law enforcement encounters. You are free to skip any question you do not wish to answer.
In this survey, we use the term “law enforcement officers” to describe all law enforcement officers and private security guards in the United States. This includes local and state police, highway patrol, sheriff’s deputies, and federal agents such as ICE, Border Patrol, and FBI. In this survey, please limit your responses to incidents that occurred with law enforcement officers in the United States.
In this survey, we use the term “law enforcement officers” to describe all law enforcement officers and private security guards in the United States. This includes local and state police, highway patrol, sheriff’s deputies, and federal agents such as ICE, Border Patrol, and FBI. In this survey, please limit your responses to incidents that occurred with law enforcement officers in the United States.
SANTA CLARA UNIVERSITY
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
CONSENT TO BE IN RESEARCH
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
CONSENT TO BE IN RESEARCH
Study Title: Justice Study
This is a research study, and you do not have to take part. The researchers, Dr. Sonja Mackenzie, Assistant Professor in the Department of Public Health at Santa Clara University, and Dr. Rupa Marya, Assistant Professor at the University of California, San Francisco, will explain this study to you. If you have any questions, you may ask the researchers.
In this study, the researchers are doing a survey to learn more about the connections between law enforcement violence and health.
You are being asked to take part in this study because you may have had experiences with law enforcement violence.
About 1,030 people will participate in this study.
What will happen if I take part in this study?
If you agree to be in this study, you will complete a survey online. The survey asks about your experiences with law enforcement violence and community violence, your health, your living situation and certain demographic information including income, race/ethnicity, zip code, sexual orientation, and gender. It will take you about 20-40 minutes to complete the survey.
Are there any risks to me or my privacy?
Some of the survey questions may make you feel uncomfortable or raise unpleasant memories. You are free to skip any question.
As researchers we are not qualified to provide counseling services and we will not be following up with you after this study. If you feel upset or find that some questions or aspects of the study triggered distress, talking with a qualified clinician may help. If you feel you would like assistance please contact the National Alliance on Mental Illness helpline at 800-950-6264 (NAMI) or, in a crisis, text NAMI (6264) to 741741.
Participation in research may cause a loss of privacy. In this survey, you will be asked about illegal activities. The researchers will keep information about you as confidential as possible, but complete confidentiality cannot be guaranteed. On rare occasions, research records have been subpoenaed by a court. In addition, if something we learn through this research indicates that you may intend to harm yourself or others, we are obligated to report that to the appropriate authorities.
Information that identifies you will be kept secure. The survey itself will not include details that directly identify you, such as your name or address. Please do not put this information on your survey. The completed surveys will be kept secure and separate from information that identifies you. Only a small number of researchers will have direct access to completed surveys. If this study is published or presented at scientific meetings, names and other information that might identify you will not be used.
To help us protect your privacy, we have applied for a Certificate of Confidentiality from the National Institutes of Health. With this Certificate, the researchers cannot be forced to disclose information that may identify you, even by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other proceedings.
Are there benefits?
There is no benefit to you. The survey results will be used for research.
Can I say “No”?
Yes, you do not have to complete a survey. If you choose not to be in this study you will not lose any of your regular benefits, and you can still receive medical care from UCSF.
Are there any payments or costs?
You will not be paid for completing the survey. There are no costs to you.
Who can answer my questions about the study?
You can talk with the study researcher about any questions, concerns, or complaints you have about this study. Contact the study researchers: Dr. Sonja Mackenzie at (408) 551- 3424 or smackenzie@scu.edu, or Dr. Rupa Marya at 415-476-7477 or Rupa.Marya@ucsf.edu.
If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Chair of the Human Subjects Committee at Santa Clara University, through Research Compliance & Integrity at (408) 554-5591, or the University of California, San Francisco Institutional Review Board at 415-476-1814.
CONSENT
PARTICIPATION IN RESEARCH IS VOLUNTARY.
Please feel free to print or screen capture a copy of this page for your records.
If you wish to be in this study, please check “Yes” below.
Yes, I give my consent to participate in this study
No, I do not consent to participate in this study
This is a research study, and you do not have to take part. The researchers, Dr. Sonja Mackenzie, Assistant Professor in the Department of Public Health at Santa Clara University, and Dr. Rupa Marya, Assistant Professor at the University of California, San Francisco, will explain this study to you. If you have any questions, you may ask the researchers.
In this study, the researchers are doing a survey to learn more about the connections between law enforcement violence and health.
You are being asked to take part in this study because you may have had experiences with law enforcement violence.
About 1,030 people will participate in this study.
What will happen if I take part in this study?
If you agree to be in this study, you will complete a survey online. The survey asks about your experiences with law enforcement violence and community violence, your health, your living situation and certain demographic information including income, race/ethnicity, zip code, sexual orientation, and gender. It will take you about 20-40 minutes to complete the survey.
Are there any risks to me or my privacy?
Some of the survey questions may make you feel uncomfortable or raise unpleasant memories. You are free to skip any question.
As researchers we are not qualified to provide counseling services and we will not be following up with you after this study. If you feel upset or find that some questions or aspects of the study triggered distress, talking with a qualified clinician may help. If you feel you would like assistance please contact the National Alliance on Mental Illness helpline at 800-950-6264 (NAMI) or, in a crisis, text NAMI (6264) to 741741.
Participation in research may cause a loss of privacy. In this survey, you will be asked about illegal activities. The researchers will keep information about you as confidential as possible, but complete confidentiality cannot be guaranteed. On rare occasions, research records have been subpoenaed by a court. In addition, if something we learn through this research indicates that you may intend to harm yourself or others, we are obligated to report that to the appropriate authorities.
Information that identifies you will be kept secure. The survey itself will not include details that directly identify you, such as your name or address. Please do not put this information on your survey. The completed surveys will be kept secure and separate from information that identifies you. Only a small number of researchers will have direct access to completed surveys. If this study is published or presented at scientific meetings, names and other information that might identify you will not be used.
To help us protect your privacy, we have applied for a Certificate of Confidentiality from the National Institutes of Health. With this Certificate, the researchers cannot be forced to disclose information that may identify you, even by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other proceedings.
Are there benefits?
There is no benefit to you. The survey results will be used for research.
Can I say “No”?
Yes, you do not have to complete a survey. If you choose not to be in this study you will not lose any of your regular benefits, and you can still receive medical care from UCSF.
Are there any payments or costs?
You will not be paid for completing the survey. There are no costs to you.
Who can answer my questions about the study?
You can talk with the study researcher about any questions, concerns, or complaints you have about this study. Contact the study researchers: Dr. Sonja Mackenzie at (408) 551- 3424 or smackenzie@scu.edu, or Dr. Rupa Marya at 415-476-7477 or Rupa.Marya@ucsf.edu.
If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Chair of the Human Subjects Committee at Santa Clara University, through Research Compliance & Integrity at (408) 554-5591, or the University of California, San Francisco Institutional Review Board at 415-476-1814.
CONSENT
PARTICIPATION IN RESEARCH IS VOLUNTARY.
Please feel free to print or screen capture a copy of this page for your records.
If you wish to be in this study, please check “Yes” below.
Yes, I give my consent to participate in this study
No, I do not consent to participate in this study