Youth Mail Screener and Consent Process for Outcome Survey

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

Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3

Youth Mail Screener and Consent Process for Outcome Survey

OMB: 0910-0788

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Attachment 5D: informed CONSENT, longitudinal participants age 18, web survey

(For longitudinal web respondents from lead letter who are now 18 years old)

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

CONSENT

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.

Thank you for your continued interest in this study. We are interviewing about 2,100 youth across the nation in this wave of the study. We are asking for your continued participation by completing this survey. You are being asked to participate again, based on your participation in a previous survey.

Because you are 18 years old, it is not necessary for your parent or legal guardian to give their permission for you to take this survey.

This study is designed to collect data from young people 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 a $25 virtual gift card when you finish the interview. [INSERT IF DATE IS EQUAL TO OR BEFORE [INSERT DATE]] You will receive an additional $5, for a total of $30, if you complete the survey online by [INSERT DATE].

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 young people.

While the interview has some personal questions, your answers will be kept private to the extent allowed by law. 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 privacy of your data.

To help us understand changes over time, we may contact you again in the future. You can decide at a later date whether or not you would like to take any additional surveys. Those surveys will also offer $25 as a token of appreciation.

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.

1


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKing, Stephen
File Modified0000-00-00
File Created2021-01-22

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