title: The impact of perceived treatment assignment on smoking cessation outcomes among African-American smokers.
abstract: BACKGROUND
  The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding.
  
  
  OBJECTIVE
  The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignment on smoking cessation outcome rates among participants enrolled in a clinical trial of bupropion (150 mg SR, BID).
  
  
  METHODS
  Analyses were conducted on data collected during "Kick It at Swope," a double-blind, placebo-controlled, randomized trial of 600 African-American smokers. Chi-square and multiple logistic regression analyses were used to examine the impact of perception of assignment on treatment effect and cotinine-verified smoking abstinence rates.
  
  
  METHODS
  Participants were predominantly middle-aged (mean 44.7, SD 11.2), African-American women (68.6%), who smoked 19 CPD (SD = 8.1). Most had completed at least a high school education or GED (51.6%), and 55% had a monthly family income <$1,800.
  
  
  METHODS
  At week 6 (end of treatment) and week 26 (end of study), participants were asked to report their perceived treatment group assignment. Self-reported abstinence (weeks 6 and 26) was confirmed using CO and cotinine biochemical verification.
  
  
  RESULTS
  After adjusting for actual treatment assignment, age and baseline cotinine, participants who perceived being assigned to bupropion vs. placebo were more likely to be abstinent at weeks 6 (OR = 2.07, 95% CI: 1.29 to 3.33, p = 0.002) and 26 (OR = 1.85, 95% CI: 1.05 to 3.24, p = 0.032).
  
  
  CONCLUSIONS
  Results support previous research that expectation bias associated with judgment of treatment assignment is a strong predictor of outcome and confirms this relationship in a smoking cessation trial using bupropion SR among African-American smokers.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Program in Health Disparities Research, University of Minnesota, Minneapolis, MN 55414, USA. jthomas@umn.edu
authors.forename: Janet L
authors.initials: JL
authors.lastname: Thomas
authors.forename: Hongfei
authors.initials: H
authors.lastname: Guo
authors.forename: Ian M
authors.initials: IM
authors.lastname: Lynam
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Powell
authors.forename: Kolawole S
authors.initials: KS
authors.lastname: Okuyemi
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Bronars
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D016642:Bupropion / Q000627:therapeutic use; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D015990:Placebo Effect; D016540:Smoking Cessation / Q000208:ethnology* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000208:ethnology*; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion