General Population Screener and Consent Process (Youth and Parent)

DEPARTMENT OF HEALTH AND HUMAN SERVICES

­­­ _________________________________________________________________________________________________________________________

Food and Drug Administration

Center for Tobacco Products

10903 New Hampshire Avenue
Silver Spring, MD 20993-0002

Form Approved
OMB No. 0910-0753
Exp. Date 10/31/2016

[PARENT FNAME] [PARENT LNAME] [Date]

[Address1]

[Address2]

[City], [State] [Zip]

Dear [PARENT FNAME] [PARENT LNAME]:

The U.S. Food and Drug Administration’s (FDA’s) Center for Tobacco Products is conducting the second follow-up survey of the Evaluation of the Public Education Campaign on Teen Tobacco (ExPECTT). Your child, [Child’s first name], is one of more than 5,800 youth taking part in this study. We thank you and your child for your continued help in this important study.

By taking part in this round of the study, your child will contribute to valuable research related to youth awareness, exposure, and receptivity to campaign messages. Because your contribution is important, we will offer your child an incentive of $25 if they complete the survey through the website on or before [Early bird date], or $20 if they complete after [Early bird date]. If your child does not complete by this date, one of our professional interviewers will try to contact you to schedule a time to complete the survey in person.

This study will provide FDA, policy makers, and researchers important information about youth exposure to public education messages on the health risks of smoking or using other tobacco products. The information collected by this study will also improve our understanding of how public education campaigns affect youth’s attitudes, beliefs, and behaviors toward tobacco use. FDA has hired RTI International, a not-for-profit survey research organization, to conduct the study.

More information about the study is provided in the enclosed fact sheet. To complete the survey via a website on a personal computer, laptop, or tablet (the questionnaire cannot be accessed on a phone), you can complete the following steps:

1. In your web browser type the study website address: https://expectt.rti.org

2. On the login screen, type your username and password exactly as shown below:

Username: [Case ID]

Password: [Password]

3. Before your child can begin answering the survey questions, a parent or legal guardian must follow the steps to provide permission for her or him to complete the survey.

Your help with this round of the study is voluntary, but greatly appreciated. All information provided by your child will be kept private to the fullest extent allowable by law and used only for statistical purposes. You or your household will never be identified in any analysis, reports, or publications, and no one will try to sell you anything.

If you have any more questions about this study, you can call our project assistance line toll-free at 1-866-860-5184. If you have a question about your rights as a study participant, you can call RTI’s Office of Research Protection toll-free at (866) 214-2043.

Your help is very important to the success of this study, and I thank you in advance for your help.

Sincerely,

Dr. Matthew Farrelly, PhD

RTI International

Paperwork Reduction Act Statement: The public reporting burden for this collection of information has been estimated to average 10 minutes per response. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov