Youth Mail Screener and Consent Process for Outcome Survey

Attachment 5B: Informed Consent, LONGITUDINAL PARTICIPANTS aGE 18, HOUSEHOLD SURVEY

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

CONSENT

ADMINISTER ADULT RESPONDENT CONSENT TEXT

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. If you recall, your address was randomly chosen to take part in this study. 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. We will offer you $25 cash 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.

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

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.

You will answer most of the questions on the computer, so I will not see your answers. 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 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.

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.

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

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