P3. Cognitive Interview Consent Form

Attachment P3: Cognitive Interview Consent Form

Individuals 18 years of age

Understanding Use of Electronic Vapor Devices (EVDS) among Youth

Introduction:

The Centers for Disease Control and Prevention (CDC) and RTI International invite you to participate in a project. Please ask questions if there is anything you don’t understand.

What is the purpose of this project?

The purpose of this project is to test questions that will be used in future surveys of youth about tobacco use (primarily electronic vapor device use and other emerging tobacco products). Questions on youth use of marijuana in electronic devices are also included since some EVDs could be used to consume marijuana. Your feedback will help us to strengthen the survey questions.

How long will the interview be?

The interview will take 45 minutes on average.

What do you want me to do if I decide to be in the interview?

An interviewer from RTI International will ask for your thoughts on questions about tobacco products, including electronic vaping devices (including the substances that are used in EVD, like nicotine and marijuana).

Are there any risks to me if I decide to be in this project?

There is no known physical risk to you from being in this project. There is a small chance that you might feel uncomfortable by the things that are talked about during the interview. You can say you do not want to talk about any topic for any reason. You can also stop participating in the interview at any time.

Are there any benefits from being in this project?

There is no direct benefit to you for being in this project. What we learn from the project will help CDC better understand how people think about tobacco products, including electronic vaping devices.

How will the information I give you be kept private?

Some of the people working on the project may watch the interview through a one-way mirror and take notes. The interview will be audio recorded so that we can create an accurate set of notes using your exact words. To keep what you say private, we will not use your name in any interview notes and your name will not be linked to any of your responses. Instead, we will use a codename. The de-identified audio recordings and electronic notes will be stored by RTI International on a secure share drive that is password protected. The codename key and any forms that could identify you will be kept in a locked file cabinet that is separate from all de-identified audio recordings and interview notes. The codename key and forms along with the audio recordings will be destroyed after analyses are complete. The de-identified interview notes will be destroyed 3 years after the project ends. Only certain project staff who have been trained on the project will be able to access any of this information before it is destroyed. Every effort will be taken to ensure the information you share is kept private but, there is still a small chance that your privacy could be broken.

Who should I call if I have questions about this?

You may ask questions or express concerns about this consent form, the project, or report problems (e.g. any interview–related injuries) at any time before, during or after the project. You may contact Julia Kish Doto, Program Manager, Center for Communication Science, RTI International at 301-468-8280 or [email protected].

Who should I call if I have a question about my rights as a project volunteer?

If you have any questions about your rights as a participant in this project, please contact

RTI’s Office of Interview Protection toll-free at 1-866-214-2043. Leave a message with your name, phone number and someone will contact you.

Do I have to be in this project?

It is your choice to be in this project. You can choose not to talk about any topic. You can stop being in the interview at any time without penalty.

Compensation:

You will receive $40 to cover time and transportation costs.

[Verbal consent required.]

Do you provide your permission:

[YES / NO ]

Consent recorded by _____________________________ on ___/ ____/ 20__

*This consent form will be used for participants who are 18 years of age unless the project is conducted in Alabama, Mississippi, Nebraska or Puerto Rico. In those states or territories, the youth assent form should be used for participants aged 18 years because the age of majority is greater than 18 years.