General Population Screener and Consent Process (Youth and Parent)

Form Approved
OMB No. 0910-0753
Exp. Date 10/31/2016

[PARENT NAME] [Date]

[Address]

[Address #2]

[City, State, Zip]

Dear Parent,

The U.S. Food and Drug Administration’s (FDA’s) Center for Tobacco Products is conducting the next round of the Evaluation of the Public Education Campaign on Teen Tobacco (ExPECTT). Your child, [Child’s first name], is one of more than 6,800 youth who took part in the first round of this study. We thank you and your child for your help in this important study.

This study will provide FDA, policy makers, and researchers important information about youth exposure to public education messages on the health risks of smoking or using other tobacco products. The information collected by this study will also improve our understanding of how public education campaigns affect youth’s attitudes, beliefs, and behaviors toward tobacco use. FDA has hired RTI International, a not-for-profit survey research organization, to conduct the study.

By taking part in this round of the study, your child will have a unique opportunity to contribute to valuable research related to youth awareness, exposure, and receptivity to campaign messages. Because your contribution is important, we will offer your child an incentive of $25 if they complete the survey through the website before July 21^st, and $20 after July 21^st.

More information about the study is provided in the enclosed fact sheet. A professional RTI interviewer will try to call you to schedule the interview. If you and your child would rather complete this round of the study via a website on a personal computer, laptop, or tablet (the questionnaire cannot be accessed on a phone), you can complete the following steps:

1. Open your interview browser and type in the study website address: https://expectt.rti.org

2. Once you have reached the study website, type in the username and password exactly as shown below:

Username: USERNAME

Password: PASSWORD

3. Once you’ve typed in your username and password, you will see instructions for completing this round of the study. Before your child can begin answering the survey questions, a parent or legal guardian must follow the steps to provide permission for her or him to complete the survey.

Your help with this round of the study is voluntary, but greatly appreciated. All information provided by your child will be kept private to the fullest extent allowable by law and used only for statistical purposes. You or your household will never be identified in any analysis, reports, or publications, and no one will try to sell you anything.

If you have any more questions about this study, you can call RTI’s National Field Director, Melissa Hobbs, at (800) 334-8571, extension 25744. If you have a question about your rights as a study participant, you can call RTI’s Office of Research Protection toll-free at (866) 214-2043.

Your help is very important to the success of this study, and I thank you in advance for your help.

Sincerely,

Dr. Matthew Farrelly, PhD

RTI International

OMB No: 0910-0753 Expiration Date: 10/31/2016

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