Dear Participant,

My name is Valerie Stivers, RDH.  I am a graduate student in the Division of Dental Hygiene at UT Health San Antonio.

The purpose of the survey study is to determine knowledge and awareness levels of Colorado dental hygienists’ about electronic cigarette use and attitudes about providing cessation advice.

The survey will collect data from registered Colorado dental hygienists.  Participation in this survey is voluntary.  Participants may decline or leave the survey at any time.  Choosing not to participate will have no professional or personal impact on the individual.

The study will consist of an online survey of approximately 24 questions.  It should take the participant about 5 minutes to complete the survey.  This survey will consist of close ended questions, dichotomous questions, and Visual Analogue Scale (VAS) questions.

Every reasonable effort will be made to keep the survey anonymous and confidential. The Principal Investigator (PI) of this study will de-identify and aggregate data to prevent participants’ identification. The survey and all data will be stored on a secured site within the UT Health San Antonio server. Only the PI and the Thesis Chair will have access to raw data. There is minimal risk to the participant. The benefit from the survey will be to increase knowledge and awareness levels of Colorado dental hygienists about electronic cigarette usage.

The participants in this survey will not be compensated for their time and there is no cost for taking the survey.

Computer security software and hard drive security software are required by UT Health San Antonio before any surveys are distributed to maintain the confidentiality of all participants. All data will be stored on secured servers, encrypted thumb drives, or external memory. This study has IRB approval #17-271E.

Contact Information:
Valerie Stivers

The UT Health San Antonio Institutional Review Board that reviews research on human subjects can answer any questions about your rights as a research subject, and take any comments or complaints you may wish to offer.  You can contact the IRB by calling 210-567-8250, or by mail to IRB, UTHSCSA, Mail Code 7830, 7703 Floyd Curl Drive, San Antonio, TX  78229-3900.

This form is yours to keep. Download this form as a PDF.

You may open the survey in your web browser by clicking the link below: