1 CTK Youth Assent Form

OMB Control No: 0970-0401

Expiration date: 10/1/2020

Youth Remote Testing

Youth Assent for Participation in Online Research Activities

____________________________________________________________________________________Public reporting burden for this collection of information is estimated to average less than 5 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 is creating an online community with youth to guide and provide feedback on a project that we’re leading. The purpose of our project is to design a marketing campaign, game, and website for youth ages 10 – 22 that will empower them to make informed choices to help them avoid risky behaviors. With the research activities on the online community, we hope to understand what types of content, products, and design elements are most appealing to people your age.

We will not collect any personal or family health information from you. This activity is not considered research with human subjects. Researchers at RTI are conducting this project and activity using public funds. None of the researchers participating in this study 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 SRATA@rti.org. Your parent was provided with a parental permission form with similar information about the study and provided their permission for you to participate.

Procedures:

If you agree to participate, you will join an online community using the platform CMNTY. You will have the opportunity to participate in activities that we create, such as vote for their favorite designs, respond to a forum question, or complete a short questionnaire. The discussions and activities will focus on their preferences and reactions to various types of media that we're creating to support the campaign, including infographics, quizzes, and videos. Each activity should take no longer than 15 minutes to complete.

Risk/Discomforts:

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

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 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:

This study will offer you $15 in the form of an electronic gift card for movies, music, or food as a token of appreciation for your time and effort. You will receive a $15 gift card when you have completed one hours’ worth of activities.

Right to Refuse or Withdraw:

Your participation in these online research 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 research 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 RESEARCH PLATFORM

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

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Participant Name

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Participant Signature Date