• Janet L Thomas, Hongfei Guo, Ian M Lynam, Joshua N Powell, Kolawole S Okuyemi, Carrie A Bronars, and Jasjit S Ahluwalia.
• Department of Medicine, Division of General Internal Medicine, Program in Health Disparities Research, University of Minnesota, Minneapolis, MN 55414, USA. jthomas@umn.edu
• J Gen Intern Med. 2008 Sep 1; 23 (9): 136113661361-6.

BackgroundThe double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding.ObjectiveThe 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).DesignAnalyses 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.ParticipantsParticipants 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.MeasurementsAt 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.ResultsAfter 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).ConclusionsResults 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.

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