Youth Consent Form

Youth Remote Testing

Youth Assent for Participation in Online Activities

____________________________________________________________________________________Public reporting burden for this collection of information is estimated to take an average of up to 20 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.
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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 has created an online community with youth called “Insiders” to guide and provide feedback on a project that we’re leading. The purpose of our project is to design and manage a social media marketing campaign and website for youth ages 13 – 21 that empower you to make informed choices and avoid risky behaviors. With the activities on the online community, we hope to understand what types of content, products, and design elements are most appealing to people your age. Topics covered include mental health, dating and relationships, goal setting, leadership and mentorship, jobs, college, and money.

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

This form requests your assent to participate based on what the project is about and what you will be asked to do. It also tells you how we will protect your information and who you can call if you have questions. You can ask any clarifying questions about this form and project by emailing [email protected] or by sending a private message to any one of the CMNTY moderators within the platform. Your parent was provided with a parental permission form with similar information about the project and provided their permission for you to participate.

Procedures:

If you agree to participate, you will join an online community of “Insiders” 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 or journal question, or complete a short questionnaire. The discussions and activities will focus on your preferences and reactions to various topics and types of media such as infographics, quizzes, and videos. Each activity should take no longer than 15-20 minutes to complete. You may also apply for additional opportunities announced to Insiders, such as judging We Think Twice contests, participating in We Think Twice videos, and creating social media content for the campaign. These additional opportunities would take additional time, and you would receive additional incentives for your participation. However, your participation in these additional opportunities is completely voluntary and not a requirement to join the platform and earn points.

Risk/Discomforts:

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

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 that you don’t want to answer. You can stop participating at any time. The activities you choose to complete are up to you.

2. RTI will take several steps to keep your participation confidential and will not share your personal 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 you may find the activities fun and interesting. Participation also gives you access to opportunities to judge We Think Twice contests and apply for features in We Think Twice video products. You will receive points for each activity you complete, with the opportunity to redeem the points for Amazon, Starbucks, or iTunes gift cards of $15 for each 75 points you accumulate.

Right to Refuse or Withdraw:

Your participation in these online activities is voluntary. You can choose not to answer any questions and can stop participating at any time without penalty. You can delete your account and leave the online community any time. You can also select which activities you would like to complete. They are all completely optional.

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).

STATEMENT OF ASSENT FOR THE ONLINE PLATFORM

I have read this assent form, which describes the benefits, risks and procedures for this online community. I agree to participate.

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Participant Name

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Participant Signature Date