BACKGROUND: The extent to which parental consent influences participant recruitment and outcomes in studies targeting children and young people remains an ongoing area of investigation. In this evaluation, we explore the impact of passive (opt-out) and active (opt-in) parental consent on overall program participation and prevalence rates of key health indicators in a school-based survey among public high school youth in Hawaii.
METHODS: The Youth Risk Behavior Survey (YRBS) is a biannual survey that is administered nationally to monitor priority health-risk behaviors. YRBS completion rates were assessed for students attending more than 30 public high schools representing 4 counties (Honolulu, Maui, Kauai, Hawaii) across the State of Hawaii for the years 2013 when active consent was employed and in 2015, after the parental consent policy was modified from active to passive.
RESULTS: Of 7,674 persons within the sampling frame in the 2013 YRBS, 521 (6.8%) parents actively refused consent, 2,495 (32.5%) students were not in the classroom when the survey was administered or declined to take the survey, and 27 (0.4%) surveys did not meet completion standards and were excluded. The 2013 response rate was 60.3% (N=4,631). Of 7,811 students in the sampling frame in 2015, 349 (4.5%) parents opted their child out of taking the survey, 1,247 (16.0%) students were not in the classroom when the survey was administered or declined to take the survey, and 126 (1.6%) surveys did not meet completion standards, for a higher overall response rate of 78.0% (N=6,089). Response rates improved across all four counties, with the largest gains observed in Honolulu County (response rate in 2013: 60%, 2015: 83%) and Maui County (2013: 61%, 2015: 81%). Under conditions of passive consent, participation improved (albeit differentially) by race/ethnicity. Native Hawaiian participation increased 39.4% from 1,115 persons in 2013 to 1,554 persons in 2015. Despite changes in the consent methodology, prevalence estimates at the state level across most health-risk behaviors remained relatively unchanged from 2013 to 2015.
CONCLUSIONS: Participation in the Hawaii State YRBS increased 31% under conditions of passive, as compared to active parental consent, and led to a more representative sample without compromising overall indicator stability. Successful implementation of school-based surveys warrants careful consideration of the consent process and an understanding of factors that influence participation rates.