This is a research study to evaluate the frequency of adult health problems and concerns about health in Blackford County. We expect it will only take you 10-15 minutes to complete this survey. Adults at least 18 years old who have lived for at least 5 years in Blackford County, Indiana are eligible to participate in the survey.

This online survey is part of a larger study being conducted in Hartford City. At the end of the survey, you will be asked if you are interested in being contacted by researchers to learn more about the full study. If you select “yes” or “maybe” you will be asked to provide your name and phone number. If you select “no”, you will not be contacted.

Participating in this research will not result in any risks that are greater than you would experience in daily life. We will keep individual survey responses confidential. These will only be viewed by study staff; it is also possible Purdue personnel may review individual responses to confirm that we are following all human research protection guidelines. You do not have to participate in this study. You can stop participating at any time without penalty.

The following disclosure is made to give you an opportunity to decide if this relationship will affect your willingness to participate in the research study. T. Eric Evans is a Co-Principal Investigator on this study. He will be involved in recruitment, data collection, and data analysis for this study. T. Eric Evans is also the president of the Blackford County Concerned Citizens (BCCC) group. He is not compensated for his service as president and there are no associated financial conflicts of interest at this time that need to be disclosed.

If you have questions, comments or concerns about this research, you can talk to Dr. Ellen Wells, wells54@purdue.edu or Dr. Sherrie Steiner, steiners@pfw.edu. If you have questions about your rights while taking part in the study or have concerns about the treatment of research participants, please call the Human Research Protection Program at (765) 494-5942, email (irb@purdue.edu). To report anonymously via Purdue's Hotline see www.purdue.edu/hotline.

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