Youth Screener and Consent for Online Outcome Survey

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

Attachment 5e_Cross Sectional Social Media_Snowball 15+ Youth

Youth Screener and Consent for Online Outcome Survey

OMB: 0910-0788

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Attachment 5E: CROSS SECTIONAL social media/snowball CONSENT 15+ YEAR OLD YOUTH



Thank you for your interest in this study. We are interviewing about 2,100 youth across the nation. We will offer you a $25 virtual gift card as a token of our appreciation when you finish the interview.

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 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.

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 you have any questions about the study, you may call our research team at, [CONTACT NUMBER], or email us as [CONTACT EMAIL]. If you have any questions about your rights as a study participant, you may call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).




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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