Youth Screener and Consent for Online Outcome Survey

Attachment 5I: YOUTH ASSENT, LONGITUDINAL PARTICIPANTS, AGE 15 – 17, ORIGINALLY RECRUITED BY SOCIAL MEDIA AND PARENTAL PERMISSION WAIVED, WEB SURVEY

(For longitudinal web survey respondents who were age 15 – 17 when recruited by social media for first follow-up and parental permission was waived; for longitudinal web survey respondents who were age 13 – 14 when recruited by social media for second follow-up and who are currently 15+)

Form Approved

OMB No. 0910-0788

Exp. Date 05/31/2018

ASSENT This screen is meant to be read by YOUTHFNAME

Thank you for your continued interest in this study. We are interviewing about 2,100 youth across the nation in this wave of the study. We are asking for your continued participation by completing this web survey. You are being asked to participate again, based on your participation in a previous survey.

This study is designed to collect data from youth about tobacco use, media use, illegal behaviors, opinions about tobacco, and experiences at home and at school. It takes about 40 minutes to complete, depending on your responses. You will answer the questions online. Your answers will not be shared with your parent or guardian, but please make sure that you are in a private place when you answer the questions. We are only interested in the combined responses from those selected to participate, not just one person’s answers.

You will represent young people in this country who are similar to you. You may choose not to take part in this study, but no one else can take your place. If you decide to continue in this study, we will offer you $25 when you finish the interview.

There are no physical risks to you from participating in this interview. It is possible that some questions might make you mildly uncomfortable, depending on your responses.

There are no direct benefits to you from answering our questions. However, you will be contributing to important research related to tobacco use among youth.

While the interview has some personal questions, your answers will be kept private to the extent allowed by law. We hope that protecting your privacy will help you to give accurate answers. You can quit the interview at any time and you can refuse to answer any questions. No absolute guarantees can be made because of the technology used for electronic surveys like these, but we are taking extensive precautions to protect the privacy of your data.

To help us understand changes over time, we may contact you again in the future. You can decide at a later date whether or not you would like to take any additional surveys. Those surveys will also offer $25 as a token of appreciation.

If you have any questions about the study, you may call our research team at 800-845-6708, or email us at efectsurvey@rti.org. If you have any questions about your rights as a study participant, you may call RTI's Office of Research Protection at 1-866-214-2043 (a toll-free number).

After you select your answer, please press “Next.”

1 Yes, I agree to participate in this study.

2 No, I do not wish to participate in this study.