Youth Screener and Consent for Online Outcome Survey

Attachment 5F: youth assent, CROSS SECTIONAL participants age 13 – 14, recruited by social media, web survey

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

ASSENT

Thank you for your interest in this study. We are interviewing about 2,100 youth across the nation in this wave of the study. Your responses will help us understand the opinions and attitudes of teens like you. You may choose not to take part in this study. If you decide to participate, we will offer a $25 virtual gift card as a token of our appreciation when you finish the interview.

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 answers. You will answer the questions online. 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.

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 one additional survey in six months. That survey will also offer $25 as a token of appreciation. You can decide at a later date whether or not you want to complete that survey.

If you have any questions about the study, you may call our research team at 800-845-6708, or email us at [email protected]. If you have any questions about your rights as a study participant, you may call RTI's Office of Research Protection 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.