0990-TPP evaluation Attachment E_youth assent

Attachment E

Youth Assent

Assent to be in a Research Study

Purpose: We are inviting you to participate in a study where we are interested in finding out more about teenage pregnancy. Because you are between the ages of 15 - 19 years old, we would like to ask you questions. You will be able to tell us about yourself and what you think about your family, friends, community, drug or alcohol use, and sexual activity. Please ask questions if there is anything you don’t understand.

We have spoken with your parent and they have agreed to allow you to answer the questions. The interview will take about 45 minutes to complete. All the interviews will be conducted in your home or any other place that is convenient for you. The interview will be done using a laptop computer and head phones so that you will not feel embarrassed to answer the questions.

Risks and Benefits: You will not get any benefits from being in this project. A risk is that you may feel uncomfortable about answering questions about yourself.

Compensation: If you agree to participate in this project, you will receive $20 for the interview to help with costs associated with participating in the project. Participation in this interview is voluntary, and you will be compensated even if you do not complete the interview.

Questions: If you have any questions about this evaluation project, you can ask your parents or the researcher who visits your house.

Protection of Information: Anything we learn about you will be kept as secret as possible. None of the interview forms that we use in the study have your name on them. They only have special codes. Papers with your name on them will be kept in a locked filing cabinet. In reports, your answers will be grouped with those of others. We will never mention your name.

There are some times when we cannot promise to keep your name secret. If you tell the person who interviews you that you plan to hurt yourself or someone else, then she/he will have to tell a doctor or some other authority so that you can get help. Interviewers must obey State laws and report certain kinds of diseases that other people can catch. And they must report child abuse.

Rights Regarding Decision to Participate: I understand that I will not be in trouble if I do not want to be in the study or if I decide to quit later. I do not have to answer questions that I do not want to answer. If I change my mind and quit, all of my answers to questions will be destroyed, if that is what I want. No one will say that I can’t be in other projects because I don’t want to be in this project.

Voluntary Assent: I read this form, or it has been read to me, and I understand what it says. My questions (if any) have been answered. By pressing the “I agree” button, the survey will begin.