Adult Parental Permission Process – Outcome Survey

Attachment 5: Parental PERMISSION and Youth assent (EFECT)

Form Approved

OMB No. 0910-0788

Exp. Date 5/31/2018

RIHSC No. 15-052CTP

Parental Permission for Parents or Guardians and Youth Assent Ages 12-17 (Cross-Sectional Refresher, Household): Evaluation of the Fresh Empire Campaign on Tobacco (EFECT)

PARENTAL PERMISSION

FIRST, READ THE PARENTAL SCRIPT BELOW AND OBTAIN PERMISSION FROM THE PARENT

INTERVIEWER: SHOW SCREEN TO PARENT AND READ OUT LOUD TO THEM WHILE THEY FOLLOW ALONG

If you recall, you and your child completed a mail survey that we sent to your home. Based on that mail survey, your (PRELOAD AGE) year-old child, (CHILD’S NAME), was selected to be in this study about tobacco use and media.

We are asking your permission for your child’s participation in this survey. (CHILD’S NAME)’s participation is voluntary. This interview asks about tobacco use, media use, illegal behaviors, opinions about tobacco, and experiences at home and at school. Those who complete it will receive $25 cash.

All of your child’s answers will be kept private and used only for statistical purposes. Since your child will answer most of the questions on the computer, I will not see the answers, and we will not share the answers with you or anyone else outside the research team. 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 child’s data.

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

There are no direct benefits to your child from answering our questions. However, he or she will be contributing to important research related to tobacco use among youth. The information provided will help researchers and policymakers understand the impact and effectiveness of public education activities aimed at reducing tobacco-related death and disease.

RTI may contact you by phone or mail to ask a few questions about the quality of my work.

We may contact you again to request your permission for your child to participate in one or more additional surveys. Those surveys will also offer $25 as a token of appreciation. You can decide at a later date whether to give your child permission to complete any additional surveys. Your child will also be able to decide whether or not to complete any additional surveys.

If it is all right with you, we’ll get started.

(Can we find a private place to complete the interview?)

YOUTH ASSENT

THEN, READ THE BOXED INFORMATION BELOW BEFORE STARTING EVERY INTERVIEW WITH YOUTH AGE 12-17

INTERVIEWER: READ TO YOUTH RESPONDENT

Thank you for your interest in this study. We are interviewing about 2,100 youth across the nation in this wave of the study. You have been randomly chosen to take part. 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. We will offer you $25 cash when you finish the interview.

GIVE STUDY DESCRIPTION TO RESPONDENT IF YOU HAVE NOT ALREADY DONE SO.

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. You will answer most of the questions on the computer, so I will not see your answers. Your answers will never be seen by your parent or guardian. We are only interested in the combined responses from those selected to participate, not just one person’s answers.

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. 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.

RTI may contact you by phone or mail to ask a few questions about the quality of my work. 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. Data quality is important to this study. We reserve the right to not invite you to future surveys if we determine you have not paid enough attention to completing this survey.

If it is all right with you, let’s get started.

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