Adult Mail Screener and Consent Process for Outcome Survey

Attachment 5a: Parental PERMISSION and YOUTH assent, LONGITUDINAL PARTICIPANTS AGE 12 – 17, HOUSEHOLD SURVEY

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

PERMISSION

INTERVIEWER: SHOW SCREEN TO PARENT AND READ OUT LOUD TO THEM WHILE THEY FOLLOW ALONG

If you recall, your (PRELOAD AGE) year-old child, (CHILD’S NAME), was selected to be in this study about tobacco use and media. (CHILD’S NAME) has completed one or more surveys for this study. This interview is being conducted to measure what might have changed over time and what might have stayed the same.

We are asking your permission for your child’s participation in this follow-up survey. (CHILD’S NAME)’s participation is voluntary. Like last time, 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 cash.

All of your child’s answers will be kept private 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 the 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 privacy 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.

RTI may contact you by phone or mail to ask a few questions about the quality of my work.

We may contact you again to request your permission for your child to participate in additional surveys. Those surveys will also offer $25 as a token of appreciation. You can decide at a later date whether to give your child permission to complete any additional surveys. Your child will also be able to decide whether or not to complete any additional surveys.

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

(Can we find a private place to complete the interview?)

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

ASSENT

READ TO YOUTH RESPONDENT

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. You are being asked to participate again, based on your participation in a previous interview. 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 $25 cash when you finish the interview.

GIVE STUDY DESCRIPTION TO RESPONDENT IF THEY ASK FOR ADDITIONAL INFORMATION ABOUT THE STUDY.

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. 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 privacy of your data.

RTI may contact you by phone or mail to ask a few questions about the quality of my work. 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).

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