Motion Comic Part A

Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24—Phase 2

Generic Information Collection request under 0920-0840

Section A: Supporting Statement

March 20, 2013

CONTACT

Leigh A. Willis, PhD, MPH

Centers for Disease Control and Prevention

Division of HIV/AIDS Prevention

Epidemiology Branch

Phone: 404.639.8447

Fax: 404.639.6127

Lwillis@cdc.gov

Table of Contents

Section

A. Justification

1. Circumstances Making the Collection of Information Necessary

2. Purpose and Use of the Information Collection

3. Use of Improved Information Technology and Burden Reduction

4. Efforts to Identify Duplication and Use of Similar Information

5. Impact on Small Businesses or Other Small Entities

6. Consequences of Collecting the Information Less frequently

7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

9. Explanation of Any Payment or Gift to Respondents

10. Assurance of Confidentiality Provided to Respondents

11. Justification for Sensitive Questions

12. Estimates of Annualized Burden Hours and Costs

13. Estimates of Other Total Annual Cost Burden to Respondents and Record Keepers

14. Annualized Cost to the Government

15. Explanation for Program Changes or Adjustments

16. Plans for Tabulation and Publication and Project Time Schedule

17. Reason(s) Display of OMB Expiration Date is Inappropriate

18. Exceptions to Certification for Paperwork Reduction Act Submissions

20. Exhibits

21. Exhibit 12.A Estimated Annualized Burden Hours

22. Exhibit 12.B Estimated Annualized Burden Costs

23. Exhibit 14.A Estimated Cost to the Government

24. Exhibit 16.A Project Time Schedule

LIST OF ATTACHMENTS

Attachment 1 Data Collection Forms

1a. Study Screener

1b. Round 1 Focus Group Moderator Guide

1c. Round 2 Focus Group Moderator Guide

1d. Participant Pre-Test Survey

1e. Participant Post-Test Survey

Attachment 2 Consent forms

2a. Adult Consent

2b. Parental Consent

2c. Adolescent Assent

Attachment 3 Human Subjects Approvals

3a. CDC IRB Approval

Attachment 4 Recruitment materials

4a. Recruitment Flyer

4b. Recruitment Script

Minority HIV/AIDS Research Initiative (MARI) Project:

Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24

Supporting Statement

A. JUSTIFICATION

A.1 Circumstances Making the Collection of Information Necessary

The Centers for Disease Control and Prevention proposes to conduct a formative research study to develop and pilot test a new health communication intervention tool, an HIV and STI themed motion comic designed to reduce HIV and STI among Black Men who have sex with men, Black heterosexuals, Latino Men who have sex with men, Latino heterosexuals and White Men who have sex with men between ages 15-24 who speak English and/or Spanish. Collecting this information, developing this intervention and pilot testing this tool will add to the CDC portfolio of effective interventions for at-risk populations.

The proposed study will use focus groups and quantitative surveys to: a) develop content (storylines and messages), b) determine the presentation style of the content (visuals, sound effects, music) c) determine the feasibility and acceptability, d) determine the motion comics impact on knowledge, abilities, beliefs and intentions (KABI) related to HIV/STI prevention. The information gained from this study can benefit other researchers in several ways. First, this study will provide information feasibility, acceptability and therefore the viability of using the motion comic medium for health communication activities targeting young at-risk populations. Second, the information learned during the development process can aid other researchers who wish to design motion comics for other important health topics. Third, the findings can be used to better understand mental models about how to use new media to inform young people about HIV and STI. Finally, researchers can build on the results of this study to create new, youth-focused interventions which are low-cost, use new and emerging technologies and can be widely disseminated.

In the US United States young people (ages 15-24) are significantly affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STIs). The disease burden shouldered by young people may be due to deficits in HIV/STI knowledge, attitudes, beliefs and intentions (KABI) that may influence risk and protective behaviors for HIV/STI transmission. It is imperative that interventions targeting this population address gaps in knowledge, instill attitudes and beliefs as well as impact behavioral intentions that are consistent with HIV/STI prevention.

Story telling is a useful method of HIV/STI prevention communication and capable of impacting KABI related to HIV/STI prevention. Comic books are pragmatic means of delivering HIV/STI prevention messages using storytelling. As traditional comic books have gained increased popularity, modern technological advances in computerized graphics have provided new ways of presenting comic books and their application for HIV/STI prevention. One promising approach is the “motion comic”, a technology that digitally animates traditional comics, making them more cinematic in tone and quality with voice actors and a musical score. While there are several examples of comics being used for HIV/STI prevention in national and international settings, to date there are no “motion comics” which focus on HIV/STI prevention. While there are a number of interventions in CDC’s portfolio designed to prevent HIV/STI in this age group, there are almost no technologically-advanced health communication interventions designed specifically for young people between the ages of 15-24.

Given the current shortfall of health communication tools and methods focused on addressing HIV/STI prevention among youth, this study will produce a valuable and technologically timely tool and methodology for preventing HIV/STI among those between the ages of 15-24 that can be widely disseminated after further testing occurs with a larger sample.

This ICR request is a derivative of a previously approved Generic ICR request “Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24”. In this request we are seeking to collect additional information to inform the development of additional episodes of the motion comic series. We are requesting a review of the following data collection instruments: focus group guides for two rounds of focus groups (Attachments 1a and 1b), as well as a pre-test survey and posttest survey (Attachments 1d and 1e). By using the measures proposed we will be determining the feasibility and acceptability of the proposed health communication intervention tool.

A.1.2 Privacy Impact Assessment

The Centers for Disease Control and Prevention (CDC) will collect information in identifiable form (IIF). IIF will be collected from participants using focus groups interviews and computer assisted self-interviews by local study staff. Research staff at CDC will collect phone numbers to contact participants to take part in the focus groups and/or survey, signatures on informed consent documents, voices and names on digital recordings, and transcripts of digital recordings. Other IIF collected include age, ethnicity, sexual orientation and gender. The main purpose of collecting this information is to characterize the participants in the study. Knowledge of participant characteristics will assist with the development of the proposed and future interventions. Respondents’ names will not be used in data collected. ID numbers will be used in place of names. This information will be kept in a locked file cabinet, password protected computers and will be accessible only by the project staff. ACASI survey data will be stored on secure USB drives and then transferred to a secure electronic database as a password protected file on a password protected computer in the PI’s office. Only the Project staff will have access to the password for the master data file. The collected data is the property of CDC. After data analysis is completed, the CDC will destroy all participant IIF and data. No IIF will be transmitted to the contractor for any aspect of the products development.

A.1.3 Overview of the data collection system

The study will be completed in three phases aimed at developing a HIV/STI themed motion comic designed to deliver health communication messages that will impact the knowledge, attitudes, beliefs, and intentions about HIV/STI of young people ages 15-24 in a manner that reduces their HIV/STI risk behavior. Participants in each of the three phases will consist of members of the following at-risk groups, who are most at risk for contracting HIV and STIs based on CDC surveillance data:

1-Black Men who have sex with men

2-Black Heterosexuals

3-Latino Men who have sex with men

4-Latino Heterosexuals

5-White Men who have sex with men

All participants in all phases will be recruited and screened using convenience samples from different settings including universities, community based organizations, schools, and civic organizations that serve youth in the target age range (Attachments 4a and 4b). In order to ensure that the identified at-risk groups are enrolled we will screen potential participants using a screening form (Attachment 1a). Based on similar research studies with the target populations approximately 300 people will need to be screened in order to reach our target enrollment. We will obtain informed consent for the participants prior to beginning each data collection (Attachments 2a, b & c).

Round 1 will consist of 4 to 6 focus groups, which will focus on obtaining feedback on the motion comic tool that will be created from a previous ICR “Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24” In round 1, participants will receive surveys through Audio Computer Assisted Self Interview (ACASI) assessing their KABI about HIV/STI before and after viewing the three motion comic episodes. Subsequent data analysis will determine if the tool had any impact on KABI related to HIV/STI. Qualitative questions will focus on determining the feasibility, acceptability and the content development (storyline ideas, characters designs) for the motion comic (Attachment 1b). Separate focus groups will be conducted with each at-risk group (groups 1-5 listed above). Approximately 60 participants will take part in the focus groups (10 to 12 Black Men who have sex with men, 10-12 Black Heterosexuals, 10 to 12 Latino Men who have sex with men, 10 to 12 Latino Heterosexuals, 10 to 12 White Men who have sex with men).

Round 2 will consist of 4 to 6 focus groups, which will focus on testing the materials (story boards, scripts) created from the information provided in the round 1 focus groups(Attachment 1c). Identical to the round 1 group, round 2 focus groups will be conducted with each at-risk group. As in round 1, approximately 60 participants will take part in these focus groups, stratified by at-risk category. The content created from this data collection will be tested at a later date.

A.1.4 Items of Information to be collected

The focus groups for rounds 1 and 2 will be comprised of approximately 10-12 participants each. Focus groups are expected to last between 90 and 120 minutes. The focus group moderator guides are included here as (Attachments 1b, 1c, and 1d). The focus groups include questions regarding:

1. HIV/STI Knowledge

2. Condom Use

3. HIV Testing

4. Health Information Seeking

5. Feasibility and acceptability of a motion comic tool for HIV/STI Prevention

6. Content development for the motion comic tool

   1. Proper look and tone

   2. Story & character development

7. Future distribution methods of motion comic tool.

The pre-and post-test surveys which will be administered to the 60 participants in round 1 will assess:

• Demographics

• HIV/STI knowledge

• HIV/STI attitudes (Including HIV/STI testing and safe sex practices)

• HIV/STI beliefs (Including stigma and myths)

• HIV Related intentions to engage in behaviors that will reduce the risk of contracting HIV/STI. The questionnaire will include items about condom use, abstinence, negotiating safe sex and HIV/STI testing.

A.1.5 Identification of Website(s) and Website Content Directed at Children Under 13 Years of Age

This information collection does not involve websites or website content directed at children less than 13 years of age.

A.2. Purpose and Use of Information Collection

The purpose of the project is to conduct formative research for development and pilot testing of a motion comic tool designed to impact the HIV/STI related knowledge, attitudes, beliefs and behavioral intentions of young people (ages 15-24) in a manner that will lower their risk of contracting HIV/STI. The information collected from this study will be used to develop content and pilot test for an innovative health communication tool that can be an addition to CDC’s portfolio of HIV prevention materials. The content created from this data collection will be tested at a later date. The types of data collection activities used are the following:

A.2.1 Qualitative interviewing for surveillance, research and intervention methods and material development

Qualitative interviewing will be used with volunteer respondents between the ages of 15-24 (Black Men who have sex with men, Black Heterosexuals, Latino Men who have sex with men, Latino Heterosexuals, White Men who have sex with men) to test the acceptability and feasibility of this motion comic health communication tool, to develop the intervention content, and to test its’ impact of HIV/STI related KABI among young people. Results from the two rounds of focus groups will be used to develop and refine the intervention content for use in future full-scale intervention trials with larger samples of young people.

A.2.2 Field Testing of New methodologies and Materials

The purpose of this data collection is to conduct field tests of new methods and interventions. The objective of such testing is to evaluate the feasibility of the “new” strategies in CDC-funded projects. Specifically, this project is new and innovative because it is the first attempt to develop and test a new youth-focused technological intervention, an HIV/STI focused motion comic.

A.2.3 Testing of Communication Mental Models

The purpose of this data collection is to develop and test mental modeling methodologies. The information that will be collected in the focus groups and the quantitative surveys will be used to develop, revise, augment and finalize a pilot health communication campaign in the form of three serial HIV/STI prevention motion comic vignettes.

A.3. Use of Improved Information Technology and Burden Reduction

All of the focus groups will be recorded on digital recorders. Upon completion of each group, the digital recording will be downloaded to a computer. Each focus group will be transcribed professionally from the digital recording into a word processing file. For the pre- and post-test surveys, data will be collected using audio-computer assisted self-interview (ACASI) that will be entered into an electronic database.

A.4. Efforts to Identify Duplication and Use of Similar Information

NCHHSTP has verified that there are no other federal collections that duplicate the data collection tools and methods included in this request.

A.5. Impact on Small Businesses and Other Small Entities

No small businesses will be involved in this data collection.

A.6. Consequences of Collecting the Information Less Frequently

The activities involve a one-time collection of data. There are no legal obstacles to reducing the burden.

A.7. Special Circumstances Relating to Guidelines of 5 CFR 1320.5

This request fully complies with the regulation 5 CFR 1320.5.

A.8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside Agencies

The Federal Register notice was published for the Generic Clearance 0920-0840 on August 2, 2012 (Vol. 77, No. 149, pp. 4604-46095. There were no comments received from the public.

A.9. Explanation of Any Payment or Gift to Respondents

Project participants will receive tokens of appreciation for participation in the study. Each participant will receive $35 for the focus groups which include a pre- and post-test survey. This token is needed to facilitate the timely and adequate recruitment of participants which will improve the quality of the results. OMB (2006) stated that Agencies may justify the use of incentives by “relating past survey experience.” In the previous ICR (Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24, 220 participants were recruited due to the use of tokens.

Although there has been some debate on the necessity of offering tokens, numerous empirical studies have shown that incentives can significantly increase response rates (e.g., Abreu & Winters, 1999; Shettle & Mooney, 1999) and the use of modest incentives is expected to enhance survey response rates without biasing responses. In addition, HIV has a stigma that other health issues do not have, which makes it difficult to recruit participants for research when compared to other diseases, (e.g cancer, diabetes, obesity). One study on research participant recruitment in Hispanic communities, researchers noted that the stigma related to HIV/AIDS is a major barrier in subject recruitment for HIV/AIDS behavioral research (Shedlin, Decena, Mangadu, & Martinez, 2011).

OMB offers justification which supports the use of incentives, in this case “to improve coverage of specialized respondents, rare groups, or minority populations” (OMB, 2006).This study seeks to recruit minorities in order to conduct formative research for the development and of a motion comic tool designed to impact the HIV/STI related knowledge, attitudes, beliefs and behavioral intentions of young people (ages 15-24) in a manner that will lower their risk of contracting HIV/STI. Offering incentives is necessary to recruit minorities and historically underrepresented groups in to research. Barriers cited related to recruitment of minorities included (1) lack of trust among minority communities towards the medical research process and research (Quinn, 1997; Wrobel & Shapiro, 1999; Gauthier& Clarke, 1999; Washington, 2006)(2) a lack of competence among researchers to use culturally competent approaches for recruitment and (Brown et al., 2000; Dilworth-Anderson & Williams, 2004)(3) reluctance to participate due to inconvenience and a lack of time (Brown et al., 2000; Brown et al., 2000; Schoenfeld et al., 2000). In a recent study of recruitment and retention of BMSM by a Community Based Organization (CBO), recruiters found it difficult to retain information from the BMSM because many were reluctant to provide their names and contact information because of concerns about being seen giving these personal details to an HIV prevention program (Painter et al., 2010). Concern with potential social labeling and HIV-related stigma also may have contributed to their hesitation (Painter et al., 2010). Some of those who were screened provided incorrect contact information, making it difficult or impossible to locate them later (Painter et al., 2010). In this study, some agreed to participate in the evaluation because of the incentives that were offered (Painter et al., 2010).

A.10. Assurance of Confidentiality Provided to Respondents

After the focus group or survey is completed, all contact information of the participants will be destroyed. After the audio tapes have been transcribed, they will be deleted from the computer and erased from the recorder. Each name on the audio tapes will be changed to a general name, such as participant #1, #2, etc… in the typed transcripts.

Survey data collected will be stored in locked file box and transported to the CDC for data entry. After each data survey is entered into an electronic database it will be compiled with data that has already been collected. Compiled data will be backed up on a password-protected server.

Respondents will be told that no information in identifiable form will be available to or shared with anyone outside of the CDC. Analysis of the dataset will take place at the CDC. The information collected in this project will be owned by the CDC. CDC will be the only entity with access to the IIF and information collected. If any data is shared with anyone outside of the CDC, it will be de-identified and transferred securely to CDC on an encrypted SFTP site or on an encrypted, password protected flash drive.

Prior to participating in any phase of the study adults, the parents of teens and teens will be required to give informed consent and assent. Written consent and assent will be obtained when the participants arrive at the various focus group sites (e.g. CDC campus, local CBO).

For adults, written consent will be obtained. Once the adults read the consent or have the consent forms read to them aloud, they will have the opportunity to ask questions in each of the phases. (Attachment 2a). In all phases, the parents of teens will sign the consent form first and send it with their child to the focus group (Attachment 2b). The parent will be provided with an opportunity to ask the PI questions by calling a number provided on the consent form. The adolescent assent form will be read aloud if necessary (Attachment 2c). After they read the consent forms or the consent forms have been read for them, the child will be allowed to ask as many questions as needed to ensure they understand what they will be asked to do as part of the study prior to signing the assent form.

All consent and assent forms with participant names and signatures will be kept in a locked file cabinet in a locked room, separate from the data files. They will be taken to this location promptly after they have been collected. Adult, adolescent participants and their parents will be provided with copies of their consent and assent forms.

A.11. Justification for Sensitive Questions

The study asks adult and adolescent participants questions of a sensitive nature. Questions concerning sexual behavior and intentions will be asked of all participants. These questions are necessary to understand and assess levels of STI/HIV risk behaviors in order to develop the appropriate intervention content and health communication messages. The questions used in this project are similar to the Youth Risk Behavior Surveillance System (YRBSS) and the National HIV Behavioral Surveillance System (NHBS), which are both conducted by the CDC, measure the risk behaviors of adolescent and adults respectively. Similar to data collected in the YRBSS and NHBS, the questions refer to past behaviors rather than current behaviors so there are no questions that mandate parents’ knowledge. The verbal consent process will inform parents that their children will be asked these questions and that the researcher does not plan to share the specific information with the parent. However, the overall findings of the study will be shared with parents if they ask for them. If this makes the parent uncomfortable, they have the option of refusing to participate in the study. In no instance will a member of the research staff obtain a participant’s (adult or adolescent) social security number.

A.12. Estimates of Annualized Burden Hours and Costs

A.12.A. Estimated Annualized Burden Hours

There are several types of respondents who will participate in the study. They include Black Men who have sex with men, Black Heterosexuals, Latino Men who have sex with men, Latino Heterosexuals and White Men who have sex with men. Focus groups conducted with these types of respondents will include Adults (18-24 years old) and adolescents (15-17 years old). In order to ensure the proper number of participants in each of the phases a 1-minute study screener will be administered to 300 adults and adolescents in the target age range. A total of 120 adolescents and adults will participate in the 2-hour focus groups in rounds 1 and 2. A total of 60 adults and adolescents will participate in the 2-hour round 1 focus groups and will complete pre-test and post-test surveys designed to be completed in 15 minutes per survey.

Exhibit A.12.A Estimated Annualized Burden Hours

Type of Respondent	Form Name	Number of Respondents	Number of Responses Per Respondent	Average Burden Per Response (in Hours)	Total Burden Hours
General Public-Adults and Adolescents	Study Screener	300	1	1/60	5
General Public- Adults and Adolescents	Focus Group Guide 1	60	1	2	120
General Public- Adults and Adolescents	Focus Group Guide 2	60	1	2	120
General Public- Adults and Adolescents	Pre-test Survey	60	1	15/60	15
General Public- Adults and Adolescents	Post-test Survey	60	1	15/60	15
Total					275

A.12.B. Estimated Annualized Burden Costs

The annualized costs to the respondents are described in Exhibit A.12.B. The United States Department of Labor Statistics May, 2010. http://www.bls.gov/oes/current/oes_nat.htm was used to estimate the hourly wage rate for the general public for the purpose of this generic request. The figure of $21.35 per hour was used as an estimate of average hourly wage for adults and the figure of $7.25 is used as an estimate of average hourly wage for minors across the country. These two figures were averaged to arrive at an average wage of $14.30 per hour. Thus, the total anticipated annual cost to participants for collection of information in this project will be $3,932.50.

Exhibit A.12.B: Estimated Annualized Burden Costs

Type of Respondent (Form Name)	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs
General Public-Adults and Adolescents(Study Screener)	5	$14.30	$71.50
General Public- Adults and Adolescents (Focus Group Guide 1)	120	$14.30	$1,716.00
General Public- Adults and Adolescents (Focus Group Guide 2)	120	$14.30	$1,716.00
General Public- Adults and Adolescents (Pre-test Survey)	15	$14.30	$214.50
General Public- Adults and Adolescents (Post-test Survey)	15	$14.30	$214.50
Total	275		$3,932.50

A.13. Estimates of Other Total Annual Cost Burden to Respondents or Record Keepers

There are no costs to respondents or record keepers.

A.14. Annualized Cost to the Government

This activity will require the participation of CDC staff members. A principal investigator will be responsible for designing the study, leading the team of researchers, preparing the IRB and OMB human subjects documents, working with the designated contractor, and providing project oversight. Also necessary is a Co-principal investigator who will assist in the project design and work with the principal investigator to obtain OMB and IRB approvals. Finally, a project manager is necessary to manage the operations of the project. Travel expenses include travel for data collection (4 round trips to domestic locations to conduct focus groups). Domestic focus group locations will be selected based on a number of criteria including being located in high incidence areas, ease of access for the target population.

Exhibit A.14: Estimates of Annualized Cost to the Government

Expense Type	Expense Explanation	Annual Costs (dollars)
Direct Costs to the Federal Government	CDC, Principal Investigator (GS-13,0.25 FTE)	$22,800
	CDC, Co-Principal Investigator (GS-12, 0.20 FTE)	$16,777
	CDC, Project Manager (GS-12, .30 FTE)	$25,884
	CDC Travel for focus groups/data collection (4 domestic trips)	$8,500
	Subtotal, Direct Costs	$73,961
Cooperative Agreement or Contract Costs	Contractor Costs, TBN	$81,500
	Subtotal, Cooperative Agreement or Contract Costs	$81,500
	TOTAL COST TO THE GOVERNMENT	$ 155,461

A.15.Explanation for Program Changes or Adjustments

Not applicable – request is for a sub-collection under a generic approval.

A.16. Plans for Tabulation and Publication and Project Time Schedule

Data collection will be completed during the first year after OMB approval is granted. Round 1 data collection will be completed by 3months after approval. Round 2 of data collection will be completed by 6 months after approval, and the motion comics will be developed based on the focus group data from rounds 1 & 2. Data collection will be completed by 6 months after approval. Data analysis will be completed by 11 months after approval. Dissemination of results will begin 12 months after OMB approval.

Exhibit A.16: Project Time Schedule

Activity	Time Schedule
Recruit and conduct 1st set of focus groups	1-3 months after OMB approval
Analyze 1st set of focus groups	3-5 months after OMB approval
Recruit and Conduct 2nd set of focus groups	5-6 months after OMB approval
Analyze 2nd set of focus groups	6-8 months after OMB approval
Contractor will create motion comics based on data from phase 1 and 2 focus groups	811 months after OMB approval
Analyze quantitative survey	11 months after OMB approval
Share findings with all stakeholders	12 months after OMB approval

A.17. Reason(s) Display of OMB Expiration Date is Inappropriate

OMB Expiration Date will be displayed.

A.18. Exceptions to Certification for Paperwork Reduction Act Submissions

There are no exceptions to the certification

REFERENCES

Abreu, D. A., & Winters, F. (1999). Using monetary incentives to reduce attrition in the survey of income and program participation. Proceedings of the Survey Research Methods Section of the American Statistical Association.

Brown, B.A., Long, H.L., Gould, H., Weitz, T., & Milliken, N.(2000). A conceptual model for recruitment of diverse women into research studies. Journal of Women’s Health and Gender-Based Medicine, 9, 625-632.

Brown, D.R., Fonad, M.N., Basen-Engquist, K., & Tortolero- Luna, G. (2000). Recruitment and retention of minority women in cancer screening, prevention, and treatment trials. Annals of Epidemiology, 10, 13-21.

Dilworth-Anderson, P., & Williams, S.W. (2004). Recruitment and retention strategies for longitudinal African American caregiving research: The family caregiving project. Journal of Aging Health, 16, 137-156.

Fortenberry J.D., McFarlane, M., Bleakley, A., Bull, S.,Fishbein, M., Grimley, D.M., et al. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378- 381.

Foster, P.H. (2007). Use of stigma, fear, and denial in development of framework for prevention of HIV/AIDS in rural African American communities. Family and Community Health, 30, 318-327.

Galvan, F.H., Davis, E.M., Band, D., & Bing, E.G. (2008). HIV stigma and social support among African American. AIDS Patient Care and STIs, 22, 423-36.

Gauthier, M.A., & Clarke W.P. (1999). Gaining and sustaining minority participation in longitudinal research projects. Alzheimer Disease and Associated Disorders, 13, 29-33.

Office of Management and Budget (2006). Questions and Answers When Designing Surveys for Information Collections. Retrieved from http://www.whitehouse.gov/sites/default/files/omb/inforeg/pmc_survey_guidance_2006.pdf.

Painter, T.M., Ngalame, P.M., Lucas, B., Lauby, J.L., & Herbst, J.H. (2010). Strategies used by community based organizations to evaluate their locally developed HIV prevention interventions: Lessons learned from the CDC’s innovative interventions projects. AIDS Education and Prevention, 22, 387-401.

Quinn, S.C. (1997). Belief in AIDS as a form of genocide: Implications for HIV prevention programs for African Americans. Journal of Health Education, 28, S6-S11.

Schoenfeld, E.R., Greene, J.M., Wu S.Y., O’Leary, E., Forte, F., & Leske, M.C. (2000). Recruiting participants for community-based research: The diabetic retinopathy awareness program. Annals of Epidemiology, 10, 432-440.

Shedline, M.G., Decena, C.U., Mangadu, T., & Martinez, A. (2011). Research participant recruitment in Hispanic Communities: Lessons learned. Journal of Immigrant Minority Health, 13, 352-360.

Shettle, C., & Mooney, G. (1999). Monetary incentives in U.S. government surveys. Journal of Official Statistics, 15, 231–250.

Washington, H.A. (2006). Medical apartheid: The dark history of medical experimentation on black Americans from colonial times to present. New York: Doubleday.

Wrobel A.J., & Shapiro, N.E. (1999). Conducting research with urban elders: Issues of recruitment, data collection, and home visits. Alzheimer Disease and Associated Disorders, 13, 34-38.

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