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Psychology Today

Healthy Behaviors Checklist

We all know that smoking or habitually drinking in excess will adversely affect our health. However, you may be surprised to learn about some seemingly innocent habits that can adversely impact your health. The Healthy Behaviors Checklist is designed to sensitize you to the number of unhealthy behaviors in which you may engage on a regular basis. After the quiz, you will be given feedback concerning your responses.

Your answers will not be associated with your email address nor will they be reported in individual form. Your responses are completely anonymous. However, the data obtained through this quiz will be used for research purposes. Since this online quiz is being used for research purposes in conjunction with the University of Massachusetts- Amherst, if you would like to take the quiz, then you need to read a consent form. If you agree to participate in the study, you will be directed to the questionnaire.


"Consent Form for Participation in a Research Study: University of Massachusetts- Amherst"

Study Title: Healthy Behaviors

Principal Investigator: Susan K. Whitbourne, Ph.D.
Email: swhitbo@psych.umass.edu

Psychology Department Chair: Melinda Novak, Ph.D.
Email: mnovak@psych.umass.edu

After you have read the consent form below, click "Yes" and then click "Submit" if you agree to participate in the study.


Health Behaviors Study: Consent Form

You are being invited to participate in a research study at the University of Massachusetts Amherst entitled, “Health Behaviors Study.” This research study will attempt to identify health-related behaviors among adults. Anyone over 18 can participate but please note if you are under age 21, you will be responding to questions regarding illegal behavior (alcohol use). The questionnaire is online and will take you approximately five minutes to complete. Your participation is completely voluntary and there are no known risks. You can quit at any time or skip any questions you don’t feel comfortable answering. We do not record any personally identifiable information about you and your answers are completely confidential.

Contact Information

If you have questions, please contact Susan K. Whitbourne, Ph.D. by email at swhitbo@psych.umass.edu or the Psychology Department chair, Melinda Novak, Ph.D., mnovak@psych.umass.edu. If you have any questions concerning your rights as a research participant, you may contact the University of Massachusetts Amherst Human Research Protection Office (HRPO) at (413) 545-3428 or humansubjects@ora.umass.edu.


 

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