1 Youth Assent Form The Hive

OMB Control No: 0970-0401

Expiration date: 10/1/2020

Youth Assent Form

Instructions: Public reporting burden for this collection of information is estimated to average less than 5 minutes per response, including the time for reviewing instructions and providing the information requested. You are not required to respond to any request for information unless it displays a currently valid OMB control number.

Introduction and purpose:

RTI International is a nonprofit public health organization headquartered in Research Triangle Park, NC. RTI provides health research and technical services to government and commercial clients worldwide. RTI is creating an online community with youth to guide and provide feedback on a project that we’re leading. The purpose of our project is to design a marketing campaign, game, and website for teens like you that will empower them to make informed choices and avoid risky behaviors.

We will not collect any personal or family health information from you. This activity is not considered research with human subjects. Researchers at RTI are conducting this project and activity using public funds. None of the researchers participating in this study stand to gain anything financially or personally.

This form requests your assent to participate based on what the project is about and what your child will be asked to do. It also tells you how we will protect your child’s information and who you can call if you have questions. Please submit any questions you have via the Journal feature on CMNTY.

Procedures:

If you agree to participate, you will join an online community using the platform CMNTY. You will have the opportunity to participate in activities that we create, such as vote for your favorite designs, respond to a forum question, or complete a short questionnaire. The discussions and activities will focus on your preferences and reactions to various types of media that we're creating to support the campaign, including infographics, quizzes, and videos. Each activity should take no longer than 20 minutes to complete.

Risk/Discomforts:

There are minimal risks to you for participating in this study. There are no costs associated with taking part in this study.

1. While the discussion questions we ask are not meant to be sensitive, there is always a chance that you may feel uncomfortable with some of the questions. You do not have to answer any question or participate in any activity that you don’t want to and can stop participating at any time. The activities you choose are completely up to you.

2. RTI will take several steps to keep your participation confidential and will not share your names with anyone outside of the platform. The information that you give us will be anonymized and combined with the responses of other participants to inform our campaign design.

3. Other members in the community will be able to see your username (much like social media). Your username can be anything. You do not need to include your name or initials in it.

Benefits:

The online community and activities will provide no direct benefit to you, although they may find the session fun and interesting. Payment:

Your child will receive points for each activity they complete, with the opportunity to redeem the points in the CMNTY Webstore (e.g., Amazon or iTunes gift card).

Right to Refuse or Withdraw:

Your participation in this online community is voluntary. You can choose not to answer any questions and can stop participating at any time without penalty.

Persons to Contact:

If you have questions about the project, you can call the Project Director, Dr. Barri Burrus, at 1-800-334-8571 ext. 25109 (a toll-free number). If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection at 1-866-214-2043 (toll-free number).

I have read this assent form. I agree to participate.

I Agree I Do Not Agree

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