Informed Consent

Consent to Participate in ICF Research

Purpose

• ICF International (ICF) is conducting discussion groups for the Centers for Disease Control and Prevention (CDC) to gather your thoughts and opinions about messages developed to inform the public about electronic cigarette use among youth. We have invited you to participate in a discussion with other participants to share your knowledge and feelings about this topic.

• If you agree to participate in the discussion, here are some things you should know:

Procedures

• Any questions you have about the discussion group will be answered before we begin our discussion.

• Contact information is provided below for any questions that arise after the discussion.

• The discussion will be audio-taped so that when we write our report we can make sure we understand everything that was said.

• There will be observers from the CDC and ICF in another room and/or watching the group via a secure, password protected site on the internet. A recording will not be made of the stream.

Study Duration

• This discussion will last approximately 1.5 hours.

Payment for Participation

• You will receive $75.00 for participating in the discussion group.

Possible Risks or Discomforts

• There are minimal psychological, social, or legal risks to participating in this study. You will be asked to share your thoughts and opinions in a group setting; however, tonight’s topic is not sensitive in nature. Your participation is voluntary, and you can choose not to answer any of the questions.

Benefits

• There are no direct benefits to you for participating in this study. Your opinions will help CDC develop a public service advertisement about youth use of e-cigarettes.

Confidentiality

• Your first name only will be used in reports about this discussion group. We will be taking notes during the discussion about what was said, but we will only record your first name in noting who made the comments.

• Anything discussed during the group will be private.

• ICF and CDC will treat data in a secure manner and will not disclose unless otherwise compelled by law.

Future Contact

• We will not contact you in the future.

Your rights

• Your participation is voluntary. You can choose not to answer any question and you can leave the discussion at any time, for any reason, without penalty or loss of benefits. You will still receive the $75.00 for participating in the group.

Your questions

• If you have any questions about your participation in this discussion group or have any further questions about the project, contact Ronne Ostby, telephone number (301) 407-6594.

• Your signature below indicates that you understand the above and agree to participate in this group.

Participant Name Date

Participant Signature Witness

Thank you for your participation.