General Population Screener and Consent Process (Youth and Parent)

Attachment 10: Baseline Screener (lead) letter

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

Lead Letter for the FDA Health and Media Study

Resident at:

1234 Main Street

Anywhere, XX 12345

Dear Resident:

The Food and Drug Administration is conducting a health study in 30 cities across the United States. Your address was randomly chosen along with more than 63,000 others across the U.S. RTI International, a nonprofit research organization, was selected by the FDA to conduct this study.

Please see the enclosed brief survey for an adult household member to complete to determine your household’s eligibility for this study.

Based on the responses to the enclosed survey, a member of your household may be invited to participate. If your household is selected, an RTI interviewer will be in your neighborhood to give you more information.

• The person completing the questionnaire is welcome to keep the enclosed $2 in appreciation for his or her time.

• Because your child’s contribution is important, we will offer your child an incentive of $20 for participating. If your child participates in future rounds, he will be offered an incentive of $20 for each of the three follow-up in person interviews in which he participates.

Your participation is voluntary. You can refuse to answer any and all questions. All information provided by you 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. There are no physical risks or direct benefits to you from answering our questions. However, you will be contributing to important research related to youth attitudes related to health, health behaviors, and advertisements they may have seen on TV and/or online.

Please share this information with any others in your household. Feel free to ask the interviewer any questions you have about this study. For more information about the study, you can call our project assistance line toll-free at (866) 214-2039, or email us at mediastudy@rti.org. 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 this study’s success. Thank you for your cooperation.

Sincerely,

Dr. Matthew Farrelly, PhD

RTI International

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

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