Exercise and Dietary Habits, Mental Health, and Treatment-Seeking Behaviors
Consent Form

You are being asked to participate in a project conducted through Maryville University by Cora Lasich, Maryville Senior Seminar student and Dr. Mark Cushman, Adjunct Instructor of Psychology. This project is being conducted in partial fulfillment of the course requirements for Senior Seminar at Maryville University. Student candidates are learning to collect and assess data, so the results of the study may not be valid. The results will not be published or presented beyond the class. This course is in compliance with the Maryville University Institutional Review Board.

The purpose of this research is to explore how nutrition, exercise habits, and perceptions of mental health relate to mental well-being and treatment-seeking behaviors among adults. If you agree to participate you will be asked to complete a one-time survey that includes questions about exercise and nutrition habits, emotional well-being, perceptions about mental health, and opinions on seeking treatment. The research will take approximately 20 minutes. This project is not expected to involve risks of harm any greater than those ordinarily encountered in daily life. However, if you experience any discomfort while responding to the survey, support is available. You can reach out to the 988 Suicide & Crisis Lifeline for free, confidential support 24/7; just call or text 988, or visit their website to chat with a professional (https://988lifeline.org). While there are not any direct benefits to participants, the anticipated benefits of this research include gaining a better understanding of how nutrition, exercise habits, and perceptions of mental health influence emotional well-being and treatment-seeking behaviors, potentially informing future health interventions and public health strategies.

All of your responses will be anonymous and will be kept confidential. In addition, no individual data from this project will be shared. The group results of data from this study will be shared with members of the Senior Seminar course and the social science faculty of the College of Arts and Sciences. Pending instructor discretion, data may also be published or presented beyond the class.

Your participation is voluntary and there is no penalty for your refusal to participate. You need not answer all questions and you are free to withdraw your consent and to discontinue your participation at any time. If you are a student, withdrawal will not affect your grade. In the event of your early withdrawal, any information that you have provided up to that time will be destroyed.

If you have any questions regarding this study, or if any problems arise, you may contact the researcher, Cora Lasich, at clasich1@live.maryville.edu or the supervising faculty member, Dr. Mark Cushman at mcushman@maryville.edu. You may also ask questions, state concerns regarding your rights as a research subject, or express any feelings of pressure to participate by contacting: Dr. Robert Bertolino, Chair of the Institutional Review Board at Maryville University, (314) 529-9659.

Maryville University investigators and their colleagues who are conducting research recognize the importance of your contribution to the research studies, which are designed to improve educational learning environments. Maryville University investigators and their staffs will make every effort to minimize, control, and treat any complication that may arise as a result of this research.

Maryville University recognizes its federally mandated responsibility to ensure that research be conducted in an ethical and scholarly manner, respecting the rights and welfare of all the human participants. Any research misconduct, including but not limited to fabrication, falsification, or plagiarism in proposing, performing and reviewing research, or in reporting research results; should be reported to Dr. Robin Grebing, the Research Integrity Officer at (314) 529-6622.

Advancing to the survey will signify your implied consent to participate. You are agreeing to participate in this study based on the information presented to you. You may choose to withdraw without prejudice or penalty. Please print a copy of this form which includes the name and phone number of the researcher and the IRB at Maryville University, should you have any questions.

The protocol number on this consent form indicates that the project has been reviewed and approved by the Maryville University Institutional Review Board.

Maryville University Institutional Review Board
Protocol Number: 25 SP SOSC 485-01-01
Initiation Date: 03/03/2025
Termination Date: 03/03/2026