Pilot of in-person Recruitment

IRB 13819

ATTACHMENT 13: SCREENER WITH INFORMED CONSENT

[FOR LONGITUDINAL RESPONDENTS THE FOLLOWING TEXT WILL BE THE FIRST SCREEN THAT RESPONDENTS SEE UPON LAUNCHING THE SURVEY]

aZA3. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

The RESPECT LGBT survey asks LGBT young adults about opinions and behaviors related to tobacco and use of media. If you recall, previously you were asked to participate in the study. RTI, a non-profit research organization, is working with the FDA to conduct this study. We are contacting you again to determine whether anything has changed, or if it has stayed the same. Before beginning the study, please answer a few questions to determine whether you are eligible. You are one of approximately 6,500 young adults within 24 cities across the United States that is being invited to take part. Your answers to the questions will be kept private to the fullest extent allowable by law, and your participation is voluntary. If we determine you are eligible for the study, you will have the opportunity to complete one or more additional online surveys on your own as part of this study for $20-$25 each.

Do you consent to participate in this survey?

1. Yes, I consent to participate in this survey - GO TO Z0

2. No, I do not want to participate in this survey

ASK: All longitudinal respondents who were recruited in Cohort 1 or Cohort 2

_________________________________________________________________________

REFSCRN. [IF ZA3 (SCREENER CONSENT) AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)= NO]

Thank you for your time.

ASK: Respondents who refuse to consent to the interview.

_________________________________________________________________________

Z0. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

Before we begin, we have a couple of general questions about you. You may have seen these questions before, but we appreciate you responding to them again.

NEXT

ASK: All longitudinal respondents who have been recruited in prior waves

_________________________________________________________________________

Z1. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

What is the 5-digit zip code where you currently live?

__ __ __ __ __ (5-digit, numeric responses only)

ASK: All longitudinal respondents who have been recruited in prior waves _________________________________________________________________________

Z2. [IF LONGITUDINAL (RFU1=1)]

What is your date of birth?

Month Year

PROGRAMMER: DISPLAY A DROP DOWN LIST OF 12 MONTHS AND ANOTHER OF YEARS 1985 – 2005.

ASK: All longitudinal respondents who have been recruited in prior waves

_________________________________________________________________________

Z3. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

What is your current gender identity?

1 Male

2 Female

3 Trans male/Trans man

4 Trans female/Trans woman

5 Genderqueer/Gender non-conforming

6 Different identity (please state)________________________

9 Prefer not to answer

ASK: All longitudinal respondents who have been recruited in prior waves

_________________________________________________________________________

Z4. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

What sex were you assigned at birth, on your original birth certificate?

1 Female

2 Male

9 Prefer not to answer

ASK: All longitudinal respondents who have been recruited in prior waves

_________________________________________________________________________

Z5. [IF Z3= 1 or 3 AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

Which of the following best represents how you think of yourself?

1 Gay – GO TO Z9

2 Straight, that is, not gay – GO TO Z9

3 Bisexual – GO TO Z9

4 Something else – GO TO Z7

5 I don’t know the answer – GO TO Z8

9 Prefer not to answer – GO TO Z9

ASK: All longitudinal respondents who have been recruited in prior waves and who are male or trans male

_________________________________________________________________________

Z6. [IF Z3= 2 OR 4 AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)] Which of the following best represents how you think of yourself?

1 Lesbian or gay – GO TO Z9

2 Straight, that is, not lesbian or gay – GO TO Z9

3 Bisexual - GO TO Z9

4 Something else – GO TO Z7

5 I don’t know the answer – GO TO Z8

9 Prefer not to answer – GO TO Z9

ASK: All longitudinal respondents who have been recruited in prior waves and who are female or trans female

_________________________________________________________________________

Z7. [IF Z6=4 OR Z5=4 AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

What do you mean by something else?

1 You are not straight, but identify with another label such as queer, trisexual, omnisexual, or pansexual – GO TO Z9

2 You are transgender, transsexual, or gender variant - GO TO Z9

3 You have not figured out or are in the process of figuring out your sexuality - GO TO Z9

4 You do not think of yourself as having sexuality - GO TO Z9

5 You do not use labels to identify yourself - GO TO Z9

6 You mean something else (please state) - GO TO Z9 ________________

9 Prefer not to answer - GO TO Z9

ASK: All longitudinal respondents who have been recruited in prior waves and who report ‘something else’ in Z5 or Z6

_________________________________________________________________________

Z8. [IF Z6=5 OR Z5=5 AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)] What do you mean by don’t know?

1 You don’t understand the words

2 You understand the words, but you have not figured out or are in the process of figuring out your sexuality

3 You mean something else

9 Prefer not to answer

ASK: All longitudinal respondents who have been recruited in prior waves and who report ‘don’t know’ in Z6

_________________________________________________________________________

Z9. [IF LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1)]

What is your age? ____________ (Range: 15-80)

ASK: All longitudinal respondents who have been recruited in prior waves

_________________________________________________________________________

PROGRAMMER: IF LONGITUDINAL OR LONGITUDINAL NR (RNE=1) THEN SET ELIGFLAG. IF [Z1 IS THE SAME ZIP OR DMA AS FRAME INFORMATION AND Z2 MATCHES SAMPLE FRAME INFORMATION AND (LONGITUDINAL (RFU1=1) AND Z9= 18 to 26-years-old OR LONGITUDINAL NR (RNE=1) AND Z9= BASELINE AGE OR BASELINE AGE +1) AND [Z3= 3 to 5 OR Z5= 1 or 3 OR Z6= 1 or 3 OR Z7= 1 or 2 or 6] THEN ELIGFLAG=1. ELSE ELIGFLAG=2.

NOTE: This programming directs who is eligible for the study. To be eligible, respondents must be in the same zip code or the same DMA as they were previously. They must have the same date of birth as previously reported. They must be between 18 and 26 years old or be the same age as last wave or one year older than last wave. They must also be LGBT, but their sexual orientation or identity is not compared to that of last survey.

_________________________________________________________________________

INELIG [IF (ELIGFLAG=2 AND LONGITUDINAL (RFU1=1) OR LONGITUDINAL NR (RNE=1))]

Thank you for your responses. Based on your responses, you are not eligible to participate in the study. We have no further questions at this time.

ASK: Respondents who are ineligible due to responses to the screening questions. _________________________________________________________________________

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