INSTRUCTIONS:  We would appreciate you taking a few minutes to answer the following questions about this session.  Please answer the questions as truthfully as possible.  There is no right or wrong answer.  Your answers will help us understand how we can improve these sessions for other clients in the future.  Thank you.

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* 1. Date:

Date
Informed Consent
This study is being conducted on Southern University campus and the surrounding Scotlandville community.This study is designed to reduce substance abuse (underage drinking and binge drinking) through a social norms marketing approach and reduce the risk of HIV/AIDS and hepatitis using Popular Opinion Leader, D-Up Defend Yourself to change social norms making them more consistent with safer sex practices. In order to participate in this study, you must be between the ages of 18 to 24 and be a student at Southern University or reside in the Scotlandville area. Priority is given to students and Scotlandville residents belonging to social networks at-risk of substance abuse and/or the transmission of HIV/hepatitis. Individuals under the age of consent are excluded from participating in this study in that it may be too burdensome obtain parental consent and underage participants cannot provide such consent. The possible risks and/or discomforts from participating in this research are minimal. Discussions of sexual behavior and substance abuse maybe embarrassing to some, but other than that few other risks exist. The possible benefits of participating in the study include a reduction in alcohol use and risky behaviors associated with HIV transmission. Increased self-efficacy in address health related issue.Are there alternative procedures that maybe used to conduct the study? If subjects/participants do not want to take part in the study, are there other choices? Currently, other options are limited to a couple of community-based organizations that offer HIV and substance abuse awareness activities. Participants have the choice at any time to decide not to participate in the study and may withdraw (quit) without penalty. Participants may be excluded from the study if their behavior becomes so disruptive as to interfere with other participants or staff administering the program. Every effort will be made to maintain participants’ anonymity and the confidentiality of their study records. If the study findings are to be used for a presentation, report, publication, etc. it will not include any identifying information. The information will be presented in aggregate form so as not to violate confidentiality. Participants will not have to pay any charges for serving in the program. Participants serving a Popular Opinion leaders will receive a small incentive for holding risk reduction conversations with their peers. Peers may receive a maximum of $500 for holding risk reduction conversations with peers.The program encourages participants to be tested for HIV as well as other sexually transmitted diseases. Those that have positive tests for HIV or an STD will be referred for counseling and medical treatment. Although the program will collect information regarding HIV status as well as other STDs, no names or identifying information will be connected to the reporting of these results. The federal regulation known as the Privacy Rule gives you certain rights concerning the privacy of your health information. The Privacy Rule was issued under a law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Researchers covered by this regulation are required to get your authorization (permission) to use and disclose (share with others) any health related information for the purposes of this research study. You do not have to give this permission. However, if you do not, you will not be able to participate in this study.
If you have any concerns about your consent to participate in this study, contact Dr. Reginald Rackley, Chairperson of SU-BR IRB for the Protection of Human Subjects, Psychology, SUBR, Baton Rouge, LA. 70813, 771-2303 or send an email to Reginald_Rackley@subr.edu.

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* 2. Confidentiality Statement

Please rate your feelings on each of the following statements by checking the appropriate box.  Also, please give us any comments or suggestions you have to improve future sessions.

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* 3. I found the information from Part 8 of the video entitled "Wrap-Up and Feedback to Opinion Leaders" to be very helpful

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* 4. after session four, I have a better understanding of the basic statistics about HIV/AIDS, including statistics
relevant to my community. 

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* 5. I found the information from Handout L: Review of HIV Risk, and the related discussion to be very helpful.

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* 6. I intend to use the information from Handout L: Review of HIV Risk poster and the related discussion in my
conversation with friends and peers. 

I intend to use the information from the video and from Handout J Facilitators Modeling Conversations in my conversations with friends and peers.

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* 7. I intend to conduct 10 or more additional conversations with at-risk friends and peers before the next session and have agreed to do so either by raising my hand, verbally, or by signature.

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* 8. I intend to wear the Exclamation! buttons or use any program marketing materials while having risk reduction conversations with friends or peers.

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* 9. I understand the impact opinion leaders will have within the community by conducting these conversations.

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* 10. The most useful parts of this session were:

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* 11. Something I would change to make this session better would be:

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* 12. What in this session would be most helpful to you with respect to your role as an opinion leader in this community? 

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* 13. The group facilitator used clear, simple language.

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* 14. The group facilitator listened carefully to what everybody said.

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* 15. The group facilitator gave all group members a chance to contribute and ask questions.

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* 16. The group facilitator knew the subject matter.

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* 17. The group facilitator was comfortable talking about sensitive topics.

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* 18. The group facilitator defined terms in ways I could understand.

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* 19. The group facilitator was nonjudgmental 

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* 20. The group facilitator was respectful.

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* 21. The group facilitator was friendly and enthusiastic.

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* 22. The group facilitator created a comfortable learning environment

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