Youth Screener and Consent for Online Outcome Survey

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Attachment 5c_Longitudinal Web Consent and Assent

Youth Screener and Consent for Online Outcome Survey

OMB: 0910-0788

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Attachment 5C: Longitudinal WEB Parental consent and YOUTH assent


PERMISSION

The Evaluation of the Fresh Empire Campaign on Tobacco (EFECT) is a research study designed to collect data from youth in order to understand attitudes and beliefs towards tobacco use, media use, and other behaviors that are both legal and illegal.


If you recall, about 6 months ago your address was randomly chosen to take part in this study. Your [PRELOAD AGE] year-old child, [CHILD’S NAME], was selected to be in this study and completed a survey at that time. We are asking your permission for your child’s participation in this second survey.


[CHILD’S NAME]’s participation is voluntary. Like last time, this interview asks about tobacco use, media use, illegal behaviors, opinions about tobacco, and experiences at home and at school. Those who complete it will receive $25.


All of your child’s answers will be kept in strict confidence and used only for statistical purposes. No absolute guarantees can be made because of the technology used for electronic surveys like these, but we are taking extensive precautions to protect the confidentiality of your child’s data.


There are no physical risks to your child from participating in this interview. It is possible that some questions might make your child mildly uncomfortable, depending on his or her responses.


There are no direct benefits to your child from answering our questions. However, he or she will be contributing to important research related to tobacco use among youth. The information provided will help researchers and policymakers understand the impact and effectiveness of public education activities aimed at reducing tobacco-related death and disease.


RTI may contact you by phone or mail to ask a few questions about the quality of my work.


We may contact you again to request your permission for your child to participate in two additional surveys every six months. Each of those surveys offers $25 as a token of appreciation. You can decide at a later date whether to give your child permission to complete those surveys. Your child will also be able to decide whether or not to complete those surveys.


If it is all right with you, please ask your child to answer the survey. Please give them privacy so they can answer the questions on their own. If you would rather they take the survey on a different device, they can log in on that device at the link on the study letter.


After you select your answer, please press “Next.”


1 Yes, I agree to allow my child to participate in this study.

2 No, I do not want my child to participate in this study.


ASSENT

We are reaching out to kids all over the United States about a research study. If you recall, about 6 months ago your address was randomly chosen to take part in this study and you completed a survey at that time. We are asking for your continued participation by completing this web survey.


Your parent or legal guardian has given permission for you to take this survey.


This study is designed to collect data from youth about tobacco use, media use, illegal behaviors, opinions about tobacco, and experiences at home and at school. It takes about 40 minutes to complete, depending on your responses. Your answers will not be shared with your parent or guardian, but please make sure that you are in a private place when you answer the questions. We are only interested in the combined responses from those selected to participate, not just one person’s answers.


You will represent young people in this country who are similar to you. You may choose not to take part in this study, but no one else can take your place. If you decide to continue in this study, we will offer you $25 when you finish the interview.


There are no physical risks to you from participating in this interview. It is possible that some questions might make you mildly uncomfortable, depending on your responses.


There are no direct benefits to you from answering our questions. However, you will be contributing to important research related to tobacco use among youth.


While the interview has some personal questions, your answers will be kept private. We hope that protecting your privacy will help you to give accurate answers. You can quit the interview at any time and you can refuse to answer any questions. No absolute guarantees can be made because of the technology used for electronic surveys like these, but we are taking extensive precautions to protect the confidentiality of your data.


We may contact you again to invite you to participate in two additional surveys every six months. Each of those surveys offers $25 as a token of appreciation. You can decide at a later date whether or not you want to complete those surveys.

Follow-up Youth Assent

After you select your answer, please press “Next.”

1 Yes, I agree to participate in this study.

2 No, I do not wish to participate in this study.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKing, Stephen
File Modified0000-00-00
File Created2021-01-24

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