Interview consent

Informed Consent

Interview Discussion

Introduction and Purpose:

Thank you for agreeing to participate in this research study. The purpose of the study is to gain a better understanding of how people think about alcohol use. RTI International, a non-profit research organization in North Carolina, is conducting this study sponsored by the Centers for Disease Control and Prevention (CDC).

Procedures:

We are inviting you to take part in an in-person interview to collect this information. We will be conducting a total of 18 interviews for this project in several locations across the country. The discussion will last approximately 90 minutes.

Risks/Discomforts:

There are minimal risks to you for participating in this study. Some of the questions that we discuss will be related to alcohol use. While the discussion questions we ask are not meant to be sensitive, there is always a chance that you may feel uncomfortable with some of the questions. You do not have to answer any question that you don’t want to answer and you can stop participating in the discussion at any time. Your participation is completely voluntary.

Benefits:

There is no direct benefit to you for participating. However, you may find the discussion to be informative or interesting. What we learn from the discussion will also help the CDC better understand this issue and enable it to more effectively communicate with the public about alcohol use.

Confidentiality:

Your participation in this study will be kept confidential by RTI. The information that you give us will be combined with the responses of other participants in a summary report that will not identify you by name. All notes taken during the discussion will be kept in a locked file cabinet or on a password-protected computer. Only authorized project staff will be able to see them. We will also be audio recording our discussion. Transcripts and audio files with all personally identifiable information removed will be provided to the CDC after the completion of the study. The audio files will be stored on password-protected computers at RTI and CDC. You will not be contacted in the future about this study after your participation in this interview ends.

Token of Appreciation:

In appreciation for your time and travel, we will reimburse you $60 at the end of the interview.

Right to Refuse or Withdraw:

Your participation in this study is voluntary. You can choose not to talk about any topic, and you can withdraw from the study for any reason at any time without penalty.

Persons to Contact:

If you have questions about the study, you can call the Project Director, Claudia Squire, at 1-800-334-8571, ext. 26613 (toll free). She can be reached between 9:00 AM and 5:00 PM Eastern Time Monday to Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Your Consent

I have read this consent form. I had a chance to ask questions, and my questions were answered. I was given a copy of this consent form. I agree to participate in the study.

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The above document describing the benefits, risks, and procedures for this research study has been explained to me. I agree to participate.

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Signature of Participant Date

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Signature of Person Obtaining Consent Date