Establishment of a Tobacco User Panel: Focus Group Study

OMB No: 0910-0497 Expiration Date: 06/30/2014

Paperwork Reduction Act Statement: The public reporting burden for this collection of information has been estimated to average 90 minutes per response. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to [email protected].

FDA DOCUMENTATION FOR THE CLEARANCE

OF FOCUS GROUPS FOR THE TOBACCO USER PANEL

TITLE OF INFORMATION COLLECTION: Establishment of a Tobacco User Panel: Focus Group Study (OMB Control Number 0910-0497)

ATTACHMENT A

Table of Contents

A-1. Participant Recruitment Flyer

A-2. Recruitment Protocol for Focus Groups

A-3. Focus Group Moderator’s Guide

A-4. Practice Questions for Tablets

A-5. Focus Group Informed Consent Form

A-6. Example Equipment Agreement Form

A-7. Incentive Receipt Form

A-1. Participant Recruitment Flyer

Participate in a Discussion Group for a Research Study

RTI International, a not-for-profit research organization with offices in Research Triangle Park, is looking for adults to take part in discussion groups scheduled for [DATES], 2013. The purpose of these discussion groups is to get input from Triangle area residents like you to improve the materials used for a large national study. If you are eligible and participate in a discussion group, you will be given $40 in cash as a token of our appreciation. Each discussion group will take about 90 minutes. We are looking for people who must be:

1) Age 18 and over

2) Not currently serving on active duty in the military
3) Not currently employed by RTI International

4) Not a family member of an RTI employee

To find out more about the study, please contact [NAME] ([email protected]) at [PHONE]. All information you provide RTI prior to or during the discussion group will remain strictly confidential.

888-888-8888

A-2. Focus Groups for FDA Tobacco Users Panel –

Participant Recruitment and Screening Protocol

Date/Time of Call ___________________

Hello, this is [NAME] calling from RTI International. (Were you calling about the ad?)

Let me tell you a little about the study. The purpose of the study is to develop best strategies for creating a national web panel for the Food and Drug Administration. We are trying to find people who are interested in helping us by providing their opinions about some of the strategies we may use to recruit people for the panel and to keep them involved over time. If you are interested and eligible, we would like you to come to a small discussion group that will take about 90 minutes. At the end of the discussion, you will receive $40 in cash in appreciation for your time. To make sure you are eligible for the study, I need to ask you some questions. This will only take about 5 minutes. (Is this a good time?)

[RECORD CANDIDATE’S RESPONSES ON PAPER SCREENING ROSTER.]

1. Do you now smoke cigarettes every day, some days, or not at all?

1. EVERY DAY

2. SOME DAYS

3. RARELY

4. NOT AT ALL

2. Do you now smoke cigars, cigarillos, or little filtered cigars every day, some days, rarely, or not at all?

1. EVERY DAY

2. SOME DAYS

3. RARELY

4. NOT AT ALL

3. Do you now use chewing tobacco, snuff, dip, or Snus every day, some days, rarely, or not at all?

1. EVERY DAY

2. SOME DAYS

3. RARELY

4. NOT AT ALL

[CHECKPOINT 1: IF Q1=4 AND Q2=4 AND Q3=4, THANK R AND TERMINATE CALL.]

4. Have you or any member of your household ever:

   1. Lobbied on behalf of the tobacco industry? YES NO

   2. Personally represented or worked on behalf of a tobacco company in

connection with a tobacco lawsuit? YES NO

[CHECKPOINT 2: IF ANY YES in Q4, THANK R AND TERMINATE CALL.]

5. In the past 5 years, have you or any member of your household worked for any of the following:

   1. a tobacco or cigarette company? YES NO

   2. a public health or community organization involved in communicating

the dangers of smoking or the benefits of quitting? YES NO

3. a marketing, advertising, or public relations agency or department? YES NO

[CHECKPOINT 3: IF ANY YES in Q5, THANK R AND TERMINATE CALL.]

6. In the past 5 years, have you or any member of your household worked for any of the following agencies of the federal government:

   1. U.S. Food and Drug Administration (FDA)? YES NO

   2. National Institutes of Health (NIH)? YES NO

   3. Centers for Disease Control and Prevention (CDC)? YES NO

   4. Substance Abuse and Mental Health Services Administration

(SAMHSA) or Centers for Medicare & Medicaid Services (CMS)? YES NO

[CHECKPOINT 4: IF ANY YES in Q6, THANK R AND TERMINATE CALL.]

7. [RECORD GENDER.] (IF NECESSARY, ASK: ­ Are you male or female?)

1 FEMALE

2 MALE

8. How did you hear about the study?

1 FROM CRAIG’S LIST

2 FROM A FLYER

4 FROM A FRIEND OR FAMILY MEMBER

5 COMMUNITY ORGANIZATION: ____________

6 SOME OTHER METHOD ___________________

9. And how old are you?

[CODE AGE RANGE BELOW]

1 18-25

2 26-49

3 50+

[CHECKPOINT 5: IF CALLER IS UNDER 18, (S)HE IS INELIGIBLE. THANK R AND TERMINATE CALL.]

10. Are you of Hispanic, Latino, or Spanish origin?

1 YES

2 NO

11. What is your race? Please select one or more:

1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian

5 Native Hawaiian or other Pacific Islander

12. What is the highest level of education you have completed?

1 Less than high school

2 High school graduate, including GED

3 Technical or vocational school (attended or graduated) or some college

5. College graduate, including postgraduate degree

13. What was your household’s total income, from all sources, during the past 12 months? Was it …

1 Less than $30,000

2 $30,000-$49,999

3. $50,000-$74,999

3 $75,000 or more

13. In what city or town do you live?________________ [TO ASSURE PERSON IS WITHIN DRIVING DISTANCE TO RTI]

15. Would you describe where you live as urban, suburban or rural?

1 URBAN

2 SUBURBAN

3. RURAL

16. What is your ZIP code? _________________ [TO GET CENSUS INCOME DATA IF INCOME IS NOT PROVIDED]

[CHECKPOINT 6: IF SCREENER IS IN ENGLISH ASK Q17-Q18; IF SCREENER IS IN SPANISH, GO TO CHECKPOINT 7]

17. Do you speak English as your native (primary) language?

1 YES

2 NO [THANK AND TERMINATE]

18. How well would you say you read English…?

1 VERY WELL
2 WELL
3 NOT WELL [THANK AND TERMINATE]

[CHECKPOINT 7: IF SCREENER IS IN ENGLISH, GO TO CHECKPOINT 8; IF SCREENER IS IN SPANISH, CONTINUE WITH Q19-22]

19. Do you speak Spanish as your native (primary) language?

1 YES

2 NO [THANK AND TERMINATE]

20. Can you read Spanish?

1 YES

2 NO [THANK AND TERMINATE]

21. Do you speak English?
1 YES

2 NO [GO TO CHECKPOINT 8]

22. Would you say you speak English …?
1 VERY WELL [THANK AND TERMINATE]
2 WELL, OR [THANK AND TERMINATE]
3 NOT WELL

[CHECKPOINT 8: REFER TO RECRUITMENT GRID. IF THE LIMIT IS REACHED FOR THE CALLER’S AGE OR SES GROUP, THANK AND COLLECT PHONE NUMBER TO PUT ON THE WAITING LIST.]

[IF ELIGIBLE FOR ONE OF THE GROUPS, CONTINUE]:

You are eligible to participate in our focus group! Taking part in the focus group is voluntary. It will be conducted at our office in the Research Triangle Park. Any remarks from the discussion will remain confidential. As such, we will not share information you give us with anyone other than project staff. We will audio record the focus group to help us write a summary report about the findings, but the recordings will be destroyed once we complete our report.

Would you like to take part in the focus group?

1 YES [SCHEDULE FOR GROUP, PROVIDE DATE, TIME, DIRECTIONS]

2 NO [THANK AND TERMINATE CALL]

A-3. Focus Group Moderator’s Guide

MODERATOR: THIS IS A GUIDE TO HELP YOU LEAD THE DISCUSSION. YOU CAN MODIFY AND ADAPT THESE QUESTIONS TO MEET SITUATIONAL NEEDS DURING EACH SESSION.

SECTION I: INFORMED CONSENT (5 minutes)

[PARTICIPANTS SHOULD BE SEATED AROUND THE TABLE WITH THE SEAT AT THE HEAD OF THE TABLE RESERVED FOR THE MODERATOR. THE FIRST TASK WILL BE TO REVIEW THE INFORMED CONSENT FORMS AND HAVE PARTICIPANTS SIGN BOTH COPIES]

[INTRODUCTION OF SELF]: Hello, and thank you for attending this group discussion. My name is {NAME} with RTI International, a non-for-profit research company. This is {NOTE TAKER’S NAME} also with RTI International. We are working on creating a panel of adult tobacco users to participate in web surveys for the U.S. Food and Drug Administration. We want your opinion on some of the ways we plan to recruit tobacco users to become members of the survey panel and to keep them involved in completing web surveys over time.

Before we start, I would like to read through the consent form with you. The consent form provides an overview of this research study and information about your rights as a study volunteer.

[READ THROUGH CONSENT FORM, AND CONTINUE]

You have been provided with two copies. Please take a moment to review the form and once you are done, please sign both copies. RTI will keep one and you will keep one. If you have any questions, please do not hesitate to ask me.

[ALLOW PARTICIPANTS TIME TO REVIEW THE INFORMED CONSENT AND ANSWER ANY QUESTIONS THEY HAVE. THE RTI NOTETAKER WILL CHECK THE SIGNATURE AND DATE ON THE COPIES THAT RTI WILL RETAIN]

[AFTER COLLECTING THE SIGNED CONSENT FORMS, ASK PARTICIPANTS TO WRITE THEIR FIRST NAMES (OR THE NAME THEY PREFER TO BE CALLED) ON BOTH SIDES OF A “NAME TENT” AND PLACE IT SO IT CAN BE SEEN FROM THE FRONT OF THE ROOM]

SECTION II: INTRODUCTION (5 minutes)

This group discussion will focus on the best ways to recruit tobacco users and to keep them involved in a web survey panel. By web panel, I mean a group of adults who agree to participate in a series of web surveys for a specified period of time in order to represent the opinions of people like them. We want to come up with the best strategies that will attract people like you to become panel participants. I will be leading today’s discussion and {NOTETAKER’S NAME} will be taking notes. I will be showing you some materials and asking you questions to guide the discussion.

We have a few ground rules for our discussion:

• Most importantly, there are no right or wrong answers to the questions I will be asking. Everyone’s input is equally important and helpful. We are interested in all your ideas, comments, and suggestions. It is OK to disagree with what someone says, but we ask that you do so respectfully.

• We are audio recording the session and also have a note taker so we don’t miss anything that is said, but we will not link comments with anyone personally. We will only use first names during this discussion, and we won’t ask questions that would identify where you live or other personal information. The audio recording will be destroyed when we have completed the report for this study.

• Please avoid side conversations among yourselves. Only one person should speak at a time. This serves two purposes. First, it lets the whole group hear the remarks someone makes. Second, it ensures that the recording will be clear.

• To get the best benefit from this group, we want to hear from everyone in the room. Like any group, some of you may like to talk while others may tend to be quiet. Therefore, if I haven’t heard from you, I may call on you. This allows us to hear from everyone a few times by the end of the session. If you’d rather not answer a particular question, you can just tell me that you would like to “pass.”

• Please take a minute now to turn off your cell phones, so we aren’t interrupted.

• If you need to take a break or use the restroom, please leave the room quietly.

• At the end of the session, we will give you each $40 as a token of our appreciation. We will also ask you to sign a receipt to document that you have received this payment.

Are there any questions or comments? [ANSWER ANY QUESTIONS AT THIS POINT]

Before we begin, let’s introduce ourselves. We will go in the order of the month in which you were born, starting with January. Whose birthday is in January? When I call on you, please just give us your first name.

[PARTICIPANTS RAISE THEIR HANDS AND INTRODUCE THEMSELVES, GIVING THEIR FIRST NAME ONLY. THE MODERATOR GOES THROUGH EACH MONTH UNTIL EVERYONE IN THE ROOM (INCLUDING MODERATOR AND NOTETAKER) HAS INTRODUCED THEMSELVES]

SECTION III: PANEL RECRUITMENT (10 minutes)

Great! As I mentioned, we will be discussing some recruitment strategies for the tobacco user web panel.

Imagine that you were selected to take part in the web survey panel – this means that you received a letter in the mail letting you know an interviewer would be visiting soon to ask you some questions and to potentially invite you to join a web panel with other tobacco users. Next, imagine that an interviewer showed up at your door, asked you some questions related to tobacco use and invited you to join and take part in the panel. As a member of the panel, your task will be to answer tobacco-related surveys online, via the web. We will discuss what you are getting for your participation and how long you need to stay in the panel shortly, but before we do, let’s talk about the idea of a web survey panel of tobacco users:

1. What are your thoughts on such a panel, designed specifically to survey tobacco users on tobacco-related topics online? Do you like or dislike the idea? Do you have any concerns?

[PROBE IF NEEDED: Do you think people would feel stigmatized, offended, or uncomfortable being identified as “tobacco users”?]

2. Would you be willing to participate in such a tobacco user panel? Why do you say so?

Now, let me tell you a bit more about this tobacco user panel. [DISPLAY TASK CHART.] Participants will be recruited to take part in the panel for 3 years. While in the panel, they will be asked to complete a total of 8-9 web surveys on tobacco-related topics, or about 3 surveys per year. Each survey will take about 15 minutes to complete. We also want to maintain close contact with each panel member so they remain active and interested in the panel. To do this, we will contact panel members once a month to stay in touch with them and ask them to answer 5-10 short questions on various topics. Finally, we will ask panel members to update their contact and personal information twice a year. Given this scenario:

3. Would you be willing to participate in this tobacco user panel? Why do you say so?

4. What are your thoughts on the length of time a person would be expected to participate in the panel (3 years)? Is there anything you like or dislike about such a design?

5. Would you rather commit to 2 years, but receive tobacco-related web surveys more often – for example, 4-5 times per year? Which design would you prefer – 2 or 3 years of panel participation?

6. How do you feel about the monthly contacts that will keep participants in the panel active? What kind of contacts do you imagine? If we send a 5-question survey, what kind of questions do you think will be best?

Let’s talk more about our recruitment strategy:

7. What kind of information would you like to know before making a decision to join the panel? That is, what questions would you need to have answered in order to make a decision about joining such a panel? [PROBE IF NEEDED: What information would you expect to see in the letter, do you expect to see a brochure on the study, etc.?]

8. Where would you expect this kind of information to be conveyed (i.e., advance letter vs. doorstep interaction with the interviewer)?

SECTION IV: INCENTIVES (40 minutes)

Now, we want to discuss what you will get in return for your participation in the panel.

Imagine that you were selected to take part in the panel and were offered this tablet computer in order to participate in the web surveys. It is a [NAME DEVICE].

[SHOW DEVICE AND STARTING AT ONE END OF THE TABLE, ASK PARTICIPANTS TO PASS AROUND AND TAKE A CLOSER LOOK]

Participants who are selected for the tobacco user panel will be given this tablet to fill out web surveys while they are members of the panel. In order to use this tablet to complete the web surveys, a wireless Internet connection is required.

If participants don’t already have Internet access at home, or they don’t have a wireless connection, they will get it free of charge while they are in the panel – that is, it will be paid for by the project. As a reminder, participants are asked to take part in the panel for 3 years, answer tobacco-related web surveys about 3 times a year, and answer a short set of 5-10 questions once a month.

1. Would you be willing to participate in the tobacco panel if you were offered this tablet computer? Why do you say so?

2. What is your opinion of this device? (IF NEEDED, PROMPT PARTICIPANTS TO ESTIMATE VALUE OR PURCHASE PRICE, PERCEPTIONS OF QUALITY, ETC).

3. What if I told you that you will get to keep the tablet you are looking at (but not the free wireless Internet service) at the end of your 3 years on the panel? Would this change your decision to participate?

4. Imagine you are given the option of returning the tablet at the end of your 3 year participation period in exchange for a cash incentive. Would this change your decision to join the panel? What type of payment would you expect (IF PARTICIPANTS ARE HAVING A HARD TIME COMING UP WITH IDEAS, PROBE ON CURRENT VS. ORIGINAL VALUE)?

[REPEAT SECTION IV, ITEMS 1-4 FOR THE SECOND DEVICE.]

5. There will be an agreement form that will accompany the device panel members are given. It will specify that:

1. If you choose to end your participation in the tobacco user panel prior to completing your 3 years of service, you need to return the device;

2. You are responsible for safeguarding the equipment against theft, loss or damage

3. In the event of theft, loss or damage, you need to notify the FDA project staff immediately

4. You can’t alter the device or its software while you are on the panel.

What do you think about such an agreement form?

6. Would such an agreement form that is legally binding influence your decision to participate in the panel? Why?

7. What problems do you see with giving a tablet computer to panel participants?

8. [ASK ONLY ONCE, NOT FOR EACH DEVICE]: What are your thoughts about being offered free internet access if you do not already have an internet connection at home?

Now, we want to provide more information about panel participation – in addition to the device that participants will get, they will receive an incentive for each completed survey. An incentive is a token of appreciation to thank panel members for participating in the surveys. Remember, there will be about 3 web surveys per year, each lasting about 15 minutes. In addition, twice a year, personal information will be updated and every month panel members will get a notification of some sort and 5-10 short questions to keep them active. We do not plan to offer an incentive for the short monthly surveys or the personal information updates that take place twice a year. However, we are thinking about offering an incentive to panel members as a token of appreciation for completing each of the 3 15-minute web surveys each year. Given this scenario:

9. What types of incentive do you think would work best? What would keep you motivated to respond to the tobacco-related surveys that will come about 3 times per year?

10. Some of the kinds of incentives that are given to survey participants are cash, gift cards, tokens related to the study (e.g., hats, pens, mugs), or they may be entered for a larger prize in a lottery drawing. What do you think about these kinds of incentives? Which do you think would work best to keep people motivated to respond to the tobacco-related surveys that will come about 3 times a year? Why?

11. Should we keep the same type of incentive for each of the web surveys, or should we vary the type of incentive for different surveys?”

12. We are planning for such incentives to be paid after panel members complete each survey. What do you think about that?

13. In addition to being offered the tablet computer, we are currently considering a $10 incentive for each 15-minute tobacco survey that is sent to panel members 3 times a year. What do you think of this amount? Do you think it is necessary to change this amount over time?

14. What if I told you that you could receive an additional $5 if you completed the survey within one week of receiving the survey invitation?? Would this motivate you to do it early? Why or why not?

15. Do you feel we need to offer additional incentives in order to keep people in the panel for 3 years? What kind of incentives are you thinking about?

16. What do you think of a monthly lottery drawing for everyone who stays in the panel? Do you think this would motivate people to stay active in the panel? What kind of a prize would you suggest?

17. What do you think of some kind of a pay-off schedule – the longer you are in the panel, the more money you can make at the end? What kind of a schedule would you suggest? (PROBE ON REDEAMABLE POINTS OR CASH VALUE ASSOCIATED WITH THE SCHEDULE)

Before we move on, please summarize on the sheet of paper in front of you what incentive package would make you willing to sign up for the panel and participate for its three year duration. Thank you.

SECTION V: ADDITIONAL MATERIALS FOR PANEL MAINTENENCE (15 minutes)

Now, let’s talk about other materials that would motivate panel participants to stay active in the panel.

1. What do you think about receiving post cards for major holidays, such as Thanksgiving, Christmas, and your birthday? Would this have a positive effect on your willingness to stay in the web panel? Why or why not?

2. What about study-related materials, such as fact sheets or brochures that provide a summary of the study findings, or the data collected in the web surveys? Would you be interested in receiving something like that?

3. As I reminder, if you are a panel participant, you will be contacted once a month to make sure you have not had problems with the tablet computer or internet service. These monthly contacts may also include 5-10 simple questions on any topic. There will be no incentives associated with these contacts, but this is one way we want to keep participants interested and active in the panel over time. What do you think of this? Would such monthly contacts make you more likely to stay for the duration of the panel (3 years) or not? What should participants be asked to do in these monthly contacts?

4. What else can you imagine will keep you motivated to stay in the panel for the duration of the study?

Before we move on, please summarize on the sheet of paper in front of you what additional materials would make you willing to sign up for the panel and participate for its three year duration. Thank you.

SECTION VI: TESTING A MOCK SURVEY INSTRUMENT (10 minutes)

Next, I would like you to take a look at each of the tablet computers again and answer several sample questions with each device. We are not collecting any data now – we are mostly interested in what you think about answering questions on each device.

[PASS THE DEVICES STARTING AT ONE END OF THE TABLE, SO EACH PARTICIPANT HAS A CHANCE TO ANSWER THE SAME SURVEY QUESTIONS WITH EACH DEVICE. THEN ASK QUESTIONS 1-4 FOR EACH DEVICE.]

1. What would you say about your experience? Was it easy or difficult to navigate through the instrument with DEVICE?

2. Do you foresee any potential challenges people might have with this device when answering survey questions?

3. Do you think a keyboard will make the task of filling out a survey easier?

4. Now that you have answered a few sample questions with this device, would your opinion about panel participation change?

SECTION VII: CONCLUSION (5 minutes)

Are there any final comments or questions?

I want to thank you all for coming and participating. We will now distribute the $40 payment we promised you and ask you to sign a receipt form verifying that you received it.

[THE RTI NOTETAKER WILL NOW TURN OFF THE AUDIO-RECORDING]

[THE RTI NOTETAKER WILL THEN DISTRIBUTE THE CASH GIFTS IN ENVELOPES TO EACH PARTICIPANT AND COLLECT EACH PARTICIPANT’S SIGNATURE ON THE RECEIPT FORM]

A-4. Sample Questions for Focus Group Tablet Computers

FOCUS GROUP TEST QUESTIONS

T1. Have you smoked at least 100 cigarettes in your entire life?

¹ YES

² NO

T2. Please check which of the following tobacco products you are using now. [Choose all that apply.]

¹ CIGARS

² CIGARILLOS OR LITTLE FILTERED CIGARS

³ smokeless tobacco (chewing tobacco, snuf, dip, snus)

⁴ PIPE

⁵ ELECTRONIC CIGARETTES

⁶ None of the Above

T3. How old were you when you first used a tobacco product? Please give your best guess if you are unsure.

_____ YEARS OLD

Thank you for answering these sample questions. This mock survey was just to see how well you can navigate through the questionnaire. Please press [DONE] and pass the device to the person on your left.

[DONE]

A-5. Focus Group Participant Informed Consent Form

FDA Tobacco User Panel

The Food and Drug Administration (FDA) has contracted with RTI International to recruit a panel of tobacco users. For this project, RTI has been asked to conduct focus groups like this one with adults to evaluate some of the ways we plan to recruit panel members and keep them involved over time.

Your participation in this focus group will involve answering questions and discussing issues about the design of the panel, such as incentives for joining the panel, frequency of contact, and length of time involved in the panel in order to determine the best strategies to use in gaining cooperation. We just want your opinion, and there are no right or wrong answers.

Your participation in this group discussion is voluntary and you may withdraw at any time. You do not have to answer any questions that you do not want to. Your participation and any comments you make will be kept confidential. Comments from all participants will be combined in a summary report that will not identify any individual. We ask that you show consideration for others and refrain from sharing information after leaving this focus group.

Your personal information will not be connected to your feedback in any way. We will be audio recording this focus group in order to more easily prepare our summary report. The recording will be destroyed after it is used for this purpose.

This focus group will last about 90 minutes, and you will be paid $40 for your participation. There are no physical risks to you in participating in this focus group other than those associated with everyday living. There are no direct benefits to you from participating in this focus group.

If you have any questions about this focus group, please ask your group moderator. If you have any questions about your rights as a study participant, you can call RTI's Office of Research Protection at 1-866-214-2043 (a toll-free number). For any other questions about the study, you can call Susan Kinsey of RTI at 1-800-334-8571, extension 27726.

With my signature below, I confirm that this information has been explained to me and I give consent for my participation in this focus group and its audio recording.

___________________________ _________________________

Signature Participant Date

___________________________ _________________________

Signature of Moderator Date

A-6. Example Equipment Agreement Form

I, ____________________________ acknowledge receipt of the equipment listed below which is in new condition and working order. I understand that all equipment provided to me is the property of the FDA Tobacco Use Panel Survey until my term of service on the panel is complete, at which time the equipment would become my property. Further,

1. I agree that while this equipment is in my possession, I will not in any way alter the software, unless specifically instructed to do so by the FDA Tobacco Use Panel Survey technical support staff.

2. If I elect to cease participation in the panel prior to completing the agreed upon term of service, I will return all equipment immediately to the appropriate person(s) as designated by the FDA Tobacco Use Panel Survey field interviewer. I understand that failure to return equipment could result in legal action.

3. I understand that I am fully and legally responsible for taking reasonable and appropriate steps to safeguard this equipment against damage, loss, or theft.

4. In the event that equipment becomes damaged, lost or stolen, I will notify FDA Tobacco Use Panel Survey staff immediately, and in the event of theft, I will cooperate with any police investigation.

I acknowledge and confirm that I have reviewed this agreement and directed any questions pertaining to it to the FDA Tobacco Use Panel field interviewer, ___________________. I agree to adhere to this agreement at all times. I further understand that if this agreement is not upheld in any manner that legal action could occur.

This agreement is binding and shall supersede all other agreements whether in writing or verbal and shall be governing terms and conditions where a conflict may exist between the terms and conditions of this agreement and the terms and conditions of other agreements or forms.

As certified by my signature below, I hereby affirm that I have read, understand, and agree to the above terms and conditions.

Case ID# Panel Member Signature Date

Case ID# Field Interviewer Signature Date

A-7. RECEIPT FORM

(Focus Group Participation)

By my signature below I confirm that I have received $40 as payment for participating in a focus group to discuss issues about the design and recruitment strategies for a web panel of tobacco users. This focus group has been conducted by RTI International (RTI Project No: 0212926.017.000.002). This payment is given in appreciation of the time spent discussing issues such as incentives for joining the panel, frequency of contact, and length of time involved in the panel in order to determine the best strategies to use in gaining cooperation.

Respondent’s Signature: ___________ Date: ___ / ___ /___

Printed Name: _________________________________________

Moderator’s Signature: _________________________________