Youth Mail Screener and Consent Process for Outcome Survey

Attachment 5: Parental consent and adolescent assent

Introduction for Parents or Guardians and Youth Evaluation of the Fresh Empire Campaign on Tobacco (EFECT)

PERMISSION Your (PRELOAD AGE) year-old child has been selected to be in this study. Your child’s participation is voluntary. 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. Since your child will answer most of the questions on the computer, I will not see the answers, and we will not share their answers with you or anyone else outside the research team. 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.

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.

At the end of the interview, we will ask your child to provide a phone number and confirm your address, and we will use this information only for quality control purposes.

If it is all right with you, we’ll get started.

ASSENT Thank you for your interest in this study. We are interviewing about 2,100 youth across the nation. You have been randomly chosen to take part. 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. We will offer you $25 when you finish the interview.

GIVE STUDY DESCRIPTION TO RESPONDENT IF YOU HAVE NOT ALREADY DONE SO.

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 [30 minutes for the pre-campaign survey; 45 minutes for the post-campaign survey] to complete. You will answer most of the questions on the computer, so I will not see your answers. Your answers will not be shared with your parent or guardian. We are only interested in the combined responses from those selected to participate, not just one person’s answers.

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.

RTI may contact you by phone or mail to ask a few questions about the quality of my work. This is why we ask for your phone number and mailing address at the end of the interview. 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.

If it is all right with you, let’s get started.

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