FCCC LOGO Faculty Publications
Egleston BL , Cropsey KL , Lazev AB , Heckman CJ
A tutorial on principal stratification-based sensitivity analysis: application to smoking cessation studies
Clinical Trials. 2010 Jun;7(3) :286-298
PMID: ISI:000277861400010   
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Background One problem with assessing effects of smoking cessation interventions on withdrawal symptoms is that symptoms are affected by whether participants abstain from smoking during trials. Those who enter a randomized trial but do not change smoking behavior might not experience withdrawal-related symptoms. Purpose We present a tutorial of how one can use a principal stratification sensitivity analysis to account for abstinence in the estimation of smoking cessation intervention effects. The article is intended to introduce researchers to principal stratification and describe how they might implement the methods. Methods We provide a hypothetical example that demonstrates why estimating effects within observed abstention groups is problematic. We demonstrate how estimation of effects within groups defined by potential abstention that an individual would have in either arm of a study can provide meaningful inferences. We describe a sensitivity analysis method to estimate such effects, and use it to investigate effects of a combined behavioral and nicotine replacement therapy intervention on withdrawal symptoms in a female prisoner population. Results Overall, the intervention was found to reduce withdrawal symptoms but the effect was not statistically significant in the group that was observed to abstain. More importantly, the intervention was found to be highly effective in the group that would abstain regardless of intervention assignment. The effectiveness of the intervention in other potential abstinence strata depends on the sensitivity analysis assumptions. Limitations We make assumptions to narrow the range of our sensitivity analysis estimates. While appropriate in this situation, such assumptions might not be plausible in all situations. Conclusions A principal stratification sensitivity analysis provides a meaningful method of accounting for abstinence effects in the evaluation of smoking cessation interventions on withdrawal symptoms. Smoking researchers have previously recommended analyses in subgroups defined by observed abstention status in the evaluation of smoking cessation interventions. We believe that principal stratification analyses should replace such analyses as the preferred means of accounting for post-randomization abstinence effects in the evaluation of smoking cessation programs. Clinical Trials 2010; 7: 286-298. http://ctj.sagepub.com.
Egleston, Brian L. Cropsey, Karen L. Lazev, Amy B. Heckman, Carolyn J. NIH [P30 CA 06927]; National Institute on Drug Abuse of the National Institutes of Health [K23DA15774]; GlaxoSmithKline Research was supported in part by NIH grant P30 CA 06927 and an appropriation from the Commonwealth of Pennsylvania. This study was funded by a K23 award to Dr. Cropsey by the National Institute on Drug Abuse of the National Institutes of Health (Grant K23DA15774). Product support was provided by GlaxoSmithKline. 39 Sage publications ltd; 1 olivers yard, 55 city road, london ec1y 1sp, england 598tm