Focus Group Study of Adolescent and Young Adult Perceptions Related to Cigarette Smoking

Informed Consent for Participation in a
Discussion Group
ICF Macro is conducting discussion groups on behalf of the U.S. Department of
Health and Human Services to better understand consumers’ thoughts and
knowledge about cigarette smoking. We have invited you to participate in a
discussion with other consumers to share your thoughts and knowledge about
cigarette smoking.
If you consent to participate in the discussion, here are some things you should
know:
•

Your participation is totally voluntary.

•

Your name will not be used in any reports about this discussion group. We will
be taking notes during the discussion about what was said, but we will not
record who made the comments.

•

The discussion will be audio- and video-taped so that when we write our report
we can make sure we understand everything that was said.

•

There will be observers from the study group in another room taking notes
during this discussion.

•

Anything discussed during the group will be kept private to the fullest extent
allowed by law

•

You will receive $50 for participating in the group.

•

You may discontinue participation at any time, either by leaving the discussion
group or not answering a question, without penalty or loss of benefits.

•

The discussion group will last approximately 90 minutes.

•

Any questions you have about the discussion groups will be answered before we
begin our discussion. Contact information is provided below for any questions
that arise after the discussion.

•

You will be provided with a copy of this form to take with you.

Contact information: If you have any concerns about your participation in this
discussion group or have any further questions about the project, contact Ms. Edith
Stevens at ICF Macro, telephone number (301) 572-0534.
Your signature below indicates that you understand the above and agree to
participate in this group.
Print your name:

_________________________ Date:

__________________

Signature:

_________________________ Witness: __________________