Youth Baseline Questionnaire (Male Rural Smokeless)

ExPECTT Parent Permission for Youth Follow-Up Interview– Version 1A

The Evaluation of the Public Education Campaign on Teen Tobacco (ExPECTT) is a research study designed to collect data from approximately 6,800 youth about their experiences with tobacco products, media use, and other behaviors that are both legal and illegal. Follow-up surveys are being conducted to assess awareness of recent public education campaigns and receptivity to those campaign messages.

Selection of Youth

Between November 2013 and March 2014, randomly sampled households were screened to identify 5,800 youth between the ages of 11-16 to participate in an interview using a laptop computer. Your child was one of the participants. We are trying to reach those same youth approximately 16-18 months since that initial interview to complete a second follow-up interview.

We would like to invite your child to participate in this follow-up interview. To do that, we must have your permission as the parent or legal guardian before your child participates in either a web or in person interview.

Purpose of the Youth Interview

We want to interview your child about his or her views and experiences with tobacco use. Your child’s answers combined with the answers of other youth in the study will improve our understanding of how public education campaigns affect youths’ attitudes, beliefs, and behaviors toward tobacco use.

Types of Questions for Youth

The interview with your child will last about 30-40 minutes. The interview can be completed either by web or in person. Your child will be asked about his or her media use, as well as his or her attitudes and beliefs towards tobacco use. For interviews conducted in person, the interviewer will ask the first few questions and then have your child independently answer questions by entering responses directly into a laptop computer. Your child should complete the interview in a location in the household that allows him or her to answer in private.

Voluntary Participation

Your child’s participation in this study is completely voluntary. He or she can refuse to answer any and all questions. Your child has the right to stop the interview at any time. Because your child’s contribution is important, we will offer your child $25 if they complete the survey through the website on or before [EarlyBird Data], or $20 after [Early Bird Date], as a token of appreciation for participating. For each follow-up your child completes in the future, he or she will receive a token of appreciation for participating in those additional interviews.

Risks

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.

Benefits

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 policy makers understand the impact and effectiveness of public education activities aimed at reducing tobacco-related death and disease.

Future Contacts

Additional follow-up surveys are planned in order to help us better understand how youth begin using tobacco, how much and what kinds of tobacco they use, and whether they think about quitting tobacco use. Each of these additional interviews will also be completely voluntary.

Privacy

Your child’s answers will be entered into a computer and labeled with a case identification number. Your name and that of your child will not be reported with any information your child provides. Information your child provides will be combined with answers of many others and reported in a summary form. All staff involved in this research are committed to confidentiality and have signed a Privacy Pledge. Information will be kept private to the fullest extent allowable by law.

Questions

If you have any questions about the study, you may call Melissa Hobbs at the RTI, 1-800-334-8571 extension 25744 (toll-free number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

OMB No: 0910-0753 Expiration Date: 10/31/2016

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

Form Approved

OMB No. 0910-0753

Exp Date: 10/31/2016