Parent consent

Flesch-Kincaid Grade Level 7.2

Centers for Disease and Control Prevention

Parent Consent for Youth to be in a Research Study

Thank you for your interest in this research study. Before you decide whether to agree to give permission to your child (15-17) to be in this study, please read this form and ask as many questions as you need to be sure you know what the youth will be asked to do.

Introduction: This study is being done by researchers from the Centers for Disease Control and Prevention.

What is the purpose of this study? The purpose of this study is to develop a motion comic that would ultimately be an effective method for HIV/AIDS and STD prevention for youth ages 15-24. This study is important because MSM (all races), and African American and Hispanic heterosexual youth, are at higher risk for HIV/AIDS.

Why is my child being asked to be in this study? We are asking your child to be in this study because they are a youth (15-24).

How long will you need my child? The time commitment will depend on whether your child is in the focus group, completes the survey, or does both. If they are asked to be in a focus group (a small meeting), we expect that it will last about 90 to 120 minutes. If your child is asked to complete the survey, we expect that it will take them approximately 15 minutes.

What is going to happen during the study? As stated before, your child will either participate in a focus group, complete a survey, or both. At the focus group, we will ask your child to give their first name or a nick name to be called by. They will be asked to wear a name tag with their name or nickname on it. Some people who are working on the study will take notes during the focus group. Also, we plan to record what your child says on audio tape. The tapes will help us learn more about what is said by all of the youth. For the survey, your child will be asked to answer several questions about the motion comic.

What do you want my child to do if they decide to be in this study? During the focus group, they will be asked to tell us about HIV/AIDS, STD, and the style and content of motion comics that would appeal to youth like them. If they are asked to complete a survey, we would like for them to respond to the questions in the survey.

Are there any risks to my child if they decide to be in this study? There is low risk to them if they decide to be in this study. Since we may ask the group to discuss a lot of personal questions during the focus group, they may feel uneasy or have some concerns. They do not have to respond to any questions they do not want to either in the focus group or the survey.

Are there any benefits from being in this study? By being in this study your child may be able to dispel myths about HIV/AIDS and STD. They may also influence the type of motion comic that is ultimately developed and help the community in the prevention of HIV/AIDS and STD.

Will the things my child tells you be kept private? What they tell us will be kept private to the extent allowed by law. The things they tell us during the focus group and respond to in the survey will be kept secure by the research staff. We will safeguard their identity and information that they supply. That is, we will not tell anyone what they said and we will not tell anyone that they were part of a focus group or completed a survey about the study. However, if we think there may be child abuse or that they may cause harm to themselves or others, we are required by law to report this concern to the proper authorities.

What is going to happen with the audio tapes of the focus groups? After the focus group, a person working on the study will listen to the audio tape and take notes on what was said by each person. On these notes, all names will be changed to “person 1”, “person 2,” “person 3” and so on. Only the people working on the study will be able to listen to the tapes. At the end of the study, we will erase the tapes and throw them away.

What will you do with the audio tapes of the focus groups and the responses to the surveys? The tapes, notes from the focus groups and responses to the surveys will be used to write papers on what we have found. We will share our findings with the people working on the study. These people will review the focus group reports and survey responses to help us understand what we have found. We also hope to make public our findings in a journal magazine, so that we can share what we found with other people. At no time, will anyone be able to know what they said or that they were in this study from anything that we write. We will also share our overall findings with you if you would like. You may also have a copy of any of the overall reports by getting in touch with us or giving us a number where we can call you.

Is there any cost if I take part in this study? The only cost to your child for being in this study is their time for coming here today.

Is there any reimbursement if I take part in this study? There is no reimbursement for taking part in this study, although your child will receive a token of appreciation of $25 if they participate in the focus groups and an additional $10 if they complete the survey.

Who should I call if I have questions about this study or think I may have gotten sick or been harmed by this study? If you have any questions about this study or your child’s rights for being in this study, you may call Dr. Leigh Willis, 404-639-8447, or the CDC Institutional Review Board at 1- 800-584-8814.

Do I have to be in this study? Your child does not have to be in this study, it is up to them if they want to or not. You can stop being in this study at any time without any penalty or loss of benefits.

Do you have any further questions about this study?

Please print and sign your name below if you agree to have your child be in this study and have their comments recorded during the focus group. By signing your name you also agree that you have read this form and have had a chance to ask any questions you may have about the study. You will be given a copy of this consent form for you to take with you.

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Parent of Youth - Print your Name Date

Parent of Youth - Sign your Name Date

Will you allow us to keep your contact information so we can provide you the general results of the focus group? Circle yes or no.

Yes No (Please do not contact me again)

I observed the process of consent. The prospective participant read or was read this form, was given the chance to ask questions, appeared to accept the answers, and signed to enroll in the study.

Signature of Research Staff Date