Consent

Appendix B. Consent to Participate in ICF Research

Title: National Misuse of Prescription Opioid Prevention Campaign Planning.

Purpose

• ICF is conducting discussion groups for the U.S. Department of Health and Human Services (HHS) to gather your opinions about prescription opioids and your thoughts on some messages designed to prevent prescription opioid misuse among young adults. 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 recorded so that when we write our report we can make sure we understand everything that was said.

• There will also be listeners from the U.S. Department of Health and Human Services and ICF listening to the group via a password-protected web stream. The listeners will be silent during our conversation and are present to help take notes and give the moderator additional questions to ask the group.

• The listeners will keep all information confidential and will not share any information discussed during the focus group with others outside of the group.

Study Duration

• This discussion will last approximately one hour.

Payment for Participation

• You will be emailed a $25.00 gift card and a fact sheet on the dangers of prescription opioid misuse 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. The questions in the discussion are not sensitive and are not about anyone’s personal use of opioids, or the opioid use of their family or friends. Your participation is voluntary, and you can choose not to answer any of the questions.

• In the event that your experience distress or discomfort from participating, you can leave the discussion without penalty and call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline number at (1-800-662-4357) for assistance with substance misuse.

Benefits

• There are no direct benefits to you for participating in this study. Your opinions will help HHS to plan and develop a public health campaign to prevent and reduce prescription opioid misuse among young adults.

Confidentiality

• Only your first name will be used during this discussion group. We will be taking notes during the discussion about what was said, but we will not record your first name in noting who made the comments.

• Anything discussed during the group will be private unless compelled by law.

• ICF and HHS 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 $25.00 gift card for participating in the group.

Your questions

• If you have any questions about the focus group, you may contact Rosanne Hoffman at 301-407-6596 or email her at: [email protected]. You can also email Hope Cummings at [email protected].

• If you have any questions about your rights as a research participant or research-related injuries, you may contact the Institutional Review Board (IRB) at [email protected].

• 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.