Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews

Submitted to:

CDC OSH

Submitted by:

ICF

ICF proprietary and confidential. Do not copy, distribute, or disclose.

February 23, 2022

Attachment R6. NYTS Cognitive Testing Youth

Consent

Qualitative Inquiry to Support Tobacco-Related Surveillance and Applied Research

Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews

Note: After the child has been selected to participate, the parent/guardian will be sent the email and informed assent form for their child to review and electronically sign. The consent section is at 6.9 readability on the Flesch-Kincaid Grade Level scale.

Dear PARENT NAME

Your child has been selected to participate in an interview.

Please provide three dates and times between [INSERT DATE] and [INSERT DATE] that your child can participate in the interview.

Prior to their participation, your child must review and sign an informed consent. Please have your child click the link below to view the informed consent for the interview. They will be able to electronically sign.

LINK

Many thanks for your assistance in helping the Centers for Disease Control and Prevention (CDC) pretest questions on health, tobacco use, and e-cigarette use.

Sincerely,

ICF

**** YOUTH ASSENT FORM BELOW IS LINKED FROM EMAIL ABOVE ****

The Centers for Disease Control and Prevention (CDC) has hired ICF to interview 40 youth. ICF is a company that conducts research. ICF and CDC want to learn about how middle school and high school students understand and respond to survey questions on health behaviors. Your feedback will help improve the questions.

Before you agree to participate in an interview, please read the information listed below:

Procedures

• The interview will be through Microsoft Teams.

• It will last about 2 hours.

• You will be asked to read and answer questions being shown through Teams. You will then be asked to talk about why you selected your answers.

• The interview will be audio recorded.

Confidentiality

• The interview will be confidential. Your name and personal information will not be connected to recording or records of the interview.

Voluntary Participation

• Your participation in the interview is voluntary.

• You may choose not to answer questions that you do not want to answer.

• You can end the interview at any time, for any reason. You will still receive your incentive.

Risks of Participation

• There is very little risk to you.

• Some of the questions you will review are on topics that might be considered personal. It might be uncomfortable for some people to answer questions on these topics. You don’t have to answer a question if it makes you uncomfortable.

• It is best to do the interview in a private setting.

• All records and recordings are kept in private files. Only study staff will be allowed to use them. Your name and personal information will be stored separately. Your name will not be reported when study results are published or presented.

Incentive

• You will be given $50 in Amazon credit after your interview.

For More Information

Email ICF’s Research Manager, Rachel Kinder, at [email protected], or contact ICF’s Institutional Review Board (IRB) at [email protected].

Typing my name below indicates that I consent to participate in this study. I have been given a copy of this form.

Participant Signature Date