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com J Tradit Chin Med 2016 October 15; 36(5): 634-639

info@journaltcm.com ISSN 0255-2922
© 2016 JTCM. All rights reserved.

CLINICAL STUDY
TOPIC

Effect of acupuncture treatment on smoking cessation in smokers

from Hong Kong

Wang Yingying, Liu Zhao, Zhang Ou, Chen Min, Huang Lingling, Wu Yuan, Zhang Fanfan, Wu Guanyi, He Xiuq-
ing, Yang Jinsheng
aa
Wang Yingying, Zhang Ou, Wu Yuan, Zhang Fanfan, puncture for smoking cessation in Hong Kong was
Yang Jinsheng, Institute of Acupuncture and Moxibustion, male (66.7% ), but the proportion of female smok-
China Academy of Chinese Medical Sciences, Beijing ers in this study (33.3%) was higher than that of fe-
100700, China
male smokers in Hong Kong population (13.8%, P <
Liu Zhao, Tobacco Medicine Research and Clinical Smoking
Cessation Center, China-Japan Friendship Hospital, Beijing
0.05). Subjects were at the mean age of 43.83 years
100029, China; old, of which the percentage of females aged 31-40
Chen Min, Huang Lingling, Wu Guanyi, He Xiuqing, Acu- years was the highest (38.8% , P < 0.05). The mean
puncture specialist centre of Hong Kong Pok Oi Hospital, duration of smoking was 25.49 years. The number
Hong Kong, China of cigarettes smoked per day was 17.57 cigarettes.
Supported by the Special Scientific Research Fund of Tradi- Fagerstrom Test for Nicotine Dependence (FTND)
tional Chinese Medicine of China (No. 201307014) and Fund was 5.29 points. Most of the subjects had attempt-
of Department of Health of Hong Kong Special Administra-
ed quitting smoking (81.42% ). The confidence in-
tive Region [Project No. (2) in DH/FU/4-55/99/12(15)]
Corresponding to: Prof. Yang Jinsheng, Institute of Acu-
dex (7.44 points) and the readiness to quit smoking
puncture and Moxibustion, China Academy of Chinese Med- (8.13 points) were high. Subjects quitting smoking
ical Sciences, Beijing 100700, China. zml@ibucm.com were mostly due to health cause (81.91%). The ma-
Telephone: +86-13910508609 jority of subjects were at the level of middle school
Accepted: May 19, 2016 (61.63%). The higher the educational level was, the
lower the tobacco dependence was and the higher
the confidence in successfully quitting smoking
was. 50.27% of subjects chose acupuncture for
Abstract
smoking cessation mainly through friends, televi-
OBJECTIVE: To analyze the characteristics of smok- sion and network publicity. Subjects who had re-
ers treated with acupuncture for smoking cessation ceived acupuncture had the highest confidence in-
in Hong Kong. dex, while those who wanted to try a new method
METHODS: A total of 2051 subjects were recruited had the lower confidence index.
in a clinical pilot research project "acupuncture for
CONCLUSION: Acupuncture for smoking cessation
smoking cessation", which was conducted jointly
was more popular in female smokers, especially
by Institute of Acupuncture and Moxibustion, Chi-
those aged 31-40 years. The effectiveness of acu-
na Academy of Chinese Medical Sciences and Hong
puncture-smoking cessation was most significant
Kong Pok Oi Hospital from January of 2011 to De-
in the smokers over 60.
cember of 2013. The characteristics of study sub-
jects, including baseline information, smoking
background, intention to quit and influencing fac- © 2016 JTCM. All rights reserved.
tors were analyzed.
Key words: Acupuncture; Smoking cessation; To-
RESULTS: The majority of subjects treated with acu- bacco use disorder

JTCM | www. journaltcm. com 634 October 15, 2016 | Volume 36 | Issue 5 |
 Wang YY et al. / Clinical Study

INTRODUCTION 15 min every time. Acupuncture treatment lasted for

8 weeks. Abstinence rates at 8th week, 26th week and
Smoking is one of the important risk factors for lung 52nd week were taken as the outcome measures. This
cancer, chronic respiratory disease, coronary heart dis- study was approved by ethic committee of Hong Kong
ease, stroke, etc. It is estimated that there will be 8 mil- Pok Oi Hospital. The recruitment, inclusion and acu-
lion tobacco-related deaths per year in the world by puncture methods of this observational study have
2030.1 In Hong Kong Special Administrative Region been published.5
(HKSAR), there are approximately 680 000 smokers The clinical data of enrolled subjects was classified as
with over 6900 deaths every year. The first five follows: (a) Demographic information: gender, age and
death-related diseases all associated with smoking.2 educational background; (b) Smoking background:
Healthcare expenses and losses on gross domestic prod- smoking duration, number of cigarettes smoked per day,
uct (GDP) due to smoking or passive smoking reach Fagerstrom Test for Nicotine Dependence (FTND),6
5.3 billion Hong Kong dollar (HKD) per year.3 previous attempts for smoking cessation and exhaled
In order to enhance and coordinate HKSAR Govern- carbon monoxide level before acupuncture; (c) Inten-
ment's tobacco control efforts, Hong Kong Depart- tion to quit: confidence index of smoking cessation (us-
ment of Health established the Tobacco Control Office ing a visual analogue scale method: with a ruler that
in February of 2001 to provide smoking cessation in- had a scale from 0 cm to 10 cm, the subjects were told
formation, psychological treatment and medication to point out their confidence of smoking cessation,
treatment for smokers through many different smok- and the researchers recorded the number on the ruler),
ing cessation services, such as smoking cessation hot- the readiness to quit (using a visual analogue scale:
line, smoking cessation clinics and interactive online with a ruler that had a scale from 0 cm to 10 cm, the
cessation center.4 In order to further strengthen tobac- subjects were told to point out their readiness to quit
co control efforts, a clinical pilot project "acupuncture smoking, and the doctor recorded the number on the
for smoking cessation" supported by Tobacco Control ruler), the reasons for quitting and the reasons for
Office of Hong Kong Department of Health was con- choosing acupuncture.
ducted jointly by Institute of Acupuncture and Moxi-
Statistical analysis
bustion China Academy of Chinese Medical Sciences
All data were analyzed by using SPSS software (IBM
and Hong Kong Pok Oi Hospital to explore the effec-
Corp. Released 2010. IBM SPSS Statistics for Win-
tiveness of acupuncture for smoking cessation.
dows, Version 19.0. Armonk, NY: IBM Corp. USA).
Subjects involved in the pilot project "acupuncture for Continuous data were expressed as mean ± standard de-
smoking cessation" were analyzed to understand the viation ( xˉ ± s). Paired t-test was performed to test for
characteristics of smokers in Hong Kong and to pro- intra-group comparison and two samples t-test was for
vide some evidences for the clinical application of acu- inter-group comparison. Count data was tested using
puncture for smoking cessation. Chi-square statistics. P < 0.05 was the statistical signifi-
cant level.
METHODS
RESULTS
Data collection
Data of this study were collected from the active smok- Baseline characteristics of subjects
ing subjects enrolled in the clinical pilot project "acu- From 2011 to 2013, a total of 2051 subjects were re-
puncture for smoking cessation", which supported by cruited in the "acupuncture for smoking cessation".
Tobacco Control Office of Hong Kong Department Their baseline information was shown in Table 1.
of Health and conducted jointly by Institute of Acu- Characteristics of smokers according to gender
puncture and Moxibustion China Academy of Chinese Compared with female smokers, male smokers were
Medical Sciences and Hong Kong Pok Oi Hospital. older, had a longer history of smoking and had a heavi-
In this project, daily smokers at the age of 18-75 years er tobacco dependence, but they also had more confi-
old who was willing to quit smoking were included. Af- dence in quitting smoking (all P < 0.05) (Table 2).
ter signing the informed consent, subjects were treated
with acupuncture combined with psychological treat- Characteristics of smokers according to gender and
ment. The acupoints of bilateral Baihui (GV 20), Yin- age
tang (EX-HN 3), Lieque (LU 7), Hegu (LI 4), Nei- The majority (58.3%) of subjects were aged 31-50 years,
guan (PC 6), Sanyinjiao (SP 6), Taichong (LR 3) and most of which were female smokers aging 31-40 years
Zusanli (ST 36) were selected. Needles were retained (Table 3).
for 20 min. Subjects were asked to receive acupuncture
for at least 6 times within a month. In addition to acu- Characteristics of smokers according to age/smoking
puncture treatment, subjects also accepted psychologi- background
cal treatment based on their self-condition for at least Subjects younger than 20 years old had the highest

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 Wang YY et al. / Clinical Study

Table 1 The characteristics of smokers in the project of acupuncture for smoking cessation ( xˉ ± s)
Type Data Subjects
Demographic Gender [n (%)] Male 1368 (66.70)
information Female 683 (33.30)
Age (years) 43.83±12.33
Educational background [n (%)] below Primary school 95 (4.63)
Primary school 153 (7.46)
Middle school 1264 (61.63)
Pre-university 276 (13.46)
University or above 263 (12.82)
Smoking behavior Smoking duration 25.49±11.87
Number of cigarettes smoked per day 17.57±8.27
FTND 5.29±2.32
The number of attempts for none 381 (18.58)
smoking cessation [n (%)] Once 593 (28.91)
2-5 times 945 (46.08)
6-10 times 68 (3.32)
>10 times 64 (3.31)
Exhaled carbon monoxide level before acupuncture 15.09±9.45
Intention to quit Confidence index of smoking cessation 7.44±1.84
index of readiness to quit 8.12±1.72
Duet to own health [n (%)] No 373 (18.19)
Yes 1678 (81.91)
Due to family's health [n (%)] No 1210 (59.00)
Yes 841 (41.00)
Reasons for choosing acupuncture Publicity 1031 (50.27)
[n (%)] Received acupuncture before 132 (6.44)
To try a new method 577 (28.13)
Believing in acupuncture 311 (15.16)
Note: FTND: test for Nicotine Dependence;

Table 2 Characteristics of smokers according to gender

Age Smoking duration number of cigarettes FTND CO level Confidence
Gender
（year） (year) smoked per day (point) (ppm) (point)
Male 45.48a 27.38a 18.75a 5.35a 15.53a 7.48a
Female 40.67 21.67 15.19 5.18 14.24 7.36
Note: Compared with female smokers, aP < 0.05. FTND: test for Nicotine Dependence.
Table 3 Characteristics of smokers according to gender/age ings and the highest confidence index, indicating that
[n (%)] acupuncture for smoking cessation in such people may
Age (years) Male Female Total be easy to achieve success. The results were shown in
≤ 20 5 (0.37) 2 (0.29) 7 (0.34) Table 4.
21-30 172 (12.56) 112 (16.40) 284 (13.85) Characteristics of smokers according to the
31-40 363 (26.52) 265 (38.80) 628 (30.62) educational /smoking background
41-50 372 (27.17) 197 (28.84) 569 (27.74)
Subjects enrolled in this study were divided according
to the educational background. It was shown that the
51-60 266 (19.43) 76 (11.13) 342 (16.67) higher the educational level was, the lower the number
> 61 191 (13.95) 30 (4.54) 222 (10.82) of cigarettes smoked per day, FTND and exhaled CO
Total 1389 682 2051 level. The results were shown in Table 5.

FIND, exhaled CO level and the lowest confidence in- Characteristics of smokers according to number of
dex, indicating that acupuncture for smoking cessation cigarettes smoked per day
was difficult for those people. However, subjects older AS was shown in Table 6, the less the number of ciga-
than 61 years old had the lowest FIND and CO read- rettes smoked was, the lower the FIND was and the

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 Wang YY et al. / Clinical Study

Table 4 Characteristics of smokers according to age/smok- puncture for smoking cessation due to publicity. Sub-
ing background jects who had received acupuncture had the lowest
Age FTND CO level Confidence index FIND. Their confidence index was the highest and
(years) (points) (ppm) (points) they had already been prepared. Subjects who wanted
≤20 6.86abcde 19.71 abcde 6.29 to try a new method had the lowest confidence indicat-
21-30 4.86 14.33 7.21 ing they were not fully prepared. Therefore, more psy-
chological treatment should be given during cessation
31-40 5.18 15.64 7.32 invention.
41-50 4.49 15.82 7.56
Comparison with overall ex-smoking population in
51-60 5.58 15.34 7.45
Hong Kong
>61 5.14 12.23 7.76abcdf The characteristics of smokers in this study were com-
Notes: compared with smokers aged 21-30, aC < 0.05; compared pared with the status presented in thematic household
with smokers aged 31-40, bP < 0.05; compared with smokers survey report No.537 made by Hong Kong govern-
aged 41-50, cP < 0.05; compared with smokers aged 51-60, dP < ment. The results were shown in Table 8.
0.05; compared with smokers aged > 61, eP < 0.05; compared
with smokers aged < 21, fP < 0.05. FTND: test for Nicotine De-
pendence.
DISCUSSION
higher the confidence index of quitting smoking was.
The number of cigarettes smoked per day in female Tobacco control policy in Hong Kong7 is based on the
was lower than that in male. principle of diversification including taxing on tobac-
co, legislative control, health education, controlling cig-
Characteristics of smokers according to the reasons arette advertisements and publications, protecting citi-
for choosing acupuncture for smoking cessation zens against hazards of passive smoking, strictly control-
As was shown in Table 7, 50.27% of subjects chose acu- ling tobacco smuggling, and providing smoking cessa-
Table 5 Characteristics of smokers according to the educational /smoking background
Educational level Number of cigarettes smoked per day FTND (points) Confidence index (points)
< Primary school 21.03 6.08 7.18
Primary school 19.88 5.67 7.65
Middle school 17.70 5.43 7.39
Pre-university 16.04 4.96 7.53
University degree or above 14.98 abcd
4.46 abcd
7.55
Notes: compared with smokers < primary school, P < 0.05; compared with smokers in primary school, P < 0.05; compared with smokers
a b

in middle school, cP < 0.05; compared with smokers in pre-university, dP < 0.05. FTND: test for Nicotine Dependence.

Table 6 Characteristics of smokers according to number of cigarettes smoked per day

Number of cigarettes smoked per day Age (years) Percentage in female (%) FTND (points) Confidence index (points)
1-5 42.44 52.54abcd 2.20abcd 7.69abcd
6-10 41.78 47.95 3.39 7.65
11-15 43.34 33.95 5.08 7.49
16-20 44.52 28.15 5.86 7.32
>20 46.37 19.39 7.46 7.23
Notes: compared with the number of 6-10, P < 0.05; compared with the number of 11-15, P < 0.05; compared with the number of
a b

16-20, cP < 0.05; compared with the number of >20, dP < 0.05. FTND: test for Nicotine Dependence.

Table 7 Characteristics of smokers according to the reasons for choosing acupuncture

Reasons for choosing acupuncture for smoking cessation Case [n (%)] Confidence index (points) Readiness to quit
Publicity 1031 (50.27) 7.45 8.11
Received acupuncture before 132 (6.44) 7.98abc 8.53abc
To try a new method 577 (28.13) 7.10 8.00
Believing in acupuncture 311 (15.16) 7.77 8.26
Notes: compared with smokers received acupuncture before, P < 0.05; compared with smokers trying a new method, P < 0.05; compared
a b

with smokers believing in acupuncture, cP < 0.05. FTND: test for Nicotine Dependence.

JTCM | www. journaltcm. com 637 October 15, 2016 | Volume 36 | Issue 5 |
 Wang YY et al. / Clinical Study

Table 8 Comparison with overall ex-smoking population in Hong Kong

Data Data in this study (%) Data of Hong Kong population (%)
Gender Male 66.7 86.2
Female 33.3 13.8
Age (years) ≤ 20 0.3 2.4
21-30 13.8 -
31-40 30.6 9.9
41-50 27.7 16.4
51-60 16.7 21.3
> 61 10.8 50.0
Number of cigarettes smoked per day 17.6 13.5

tion services and research. According to Hong Kong increasing by over 70%. Therefore, it is urgent to find
government statistics, the percentage of smokers in a smoking cessation strategy for women.9 In this study,
Hong Kong gradually declined from 14.9% in 1993 to a total of 2051 subjects were enrolled, including 683 fe-
10.7% in 2012.8 In order to coordinate Hong Kong males (33.3% ). The proportion of female smokers in
government program "Smoke-free life", the pilot proj- this study was higher than that of female smokers in
ect "acupuncture for smoking cessation" was launched Hong Kong (15.0% ), indicating that traditional acu-
jointly in April 2010 to provide free acupuncture for puncture for smoking cessation, due to its "green", is
smoking cessation in TCM mobile medical vehicles more popular in female smokers, especially in women
throughout all over Kowloon and New Territories. aged 31-40 years.
Meanwhile, evening out-patient service was offered to
fully assist smokers to quit smoking. Currently, more Publicity to promote acupuncture for smoking
than 5000 smokers attended the service. cessation
Smoking cessation service in Hong Kong is based on
Basic characteristics of smokers treated with medication intervention. In this pilot "acupuncture for
acupuncture for smoking cessation smoking cessation", acupuncture combined with psy-
Subjects enrolled in this study were mainly males, and chological treatment were applied to provide service
the proportion was much higher than that of females. for communities, and half of the people participated in
Subjects were mainly at the age of 31-50 years old; sub- this study through friends, television and network pub-
jects younger than 20 years old were the least. The ma- licity. According to the reasons for choosing acupunc-
jority of subjects were at the level of middle school and ture, those who had received acupuncture and believed
they participated in acupuncture for smoking cessation in acupuncture had the highest confidence index in
mainly through friends, television and network publici- quitting smoking, while those who wanted to try a
ty. The mean smoking duration was 25.49 years, the new method had the lowest confidence index, indicat-
number of cigarettes smoked per day was 17.57 ciga- ing that acupuncture is a new smoking cessation inter-
rettes, and FTND was 5.29 points. Most of subjects ventions and how to advertise acupuncture and make
had attempted quitting smoking. The exhaled carbon smokers believe in acupuncture may have a very signifi-
monoxide level was 15.09 points before quitting, and cant impact on abstinence effects. It is suggested 10 that
the confidence index (7.44 points) and the degree of the promotion of acupuncture for smoking cessation
readiness to quit smoking (8.12 points) were higher. should be strengthened to make more smokers know
Subjects quitting smoking were mostly due to health about acupuncture; the service of acupuncture for
cause. smoking cessation should be provided patiently and
Subjects with higher confidence index in quitting meticulously and the successful cases on smoking cessa-
smoking scoring were those who had received acupunc- tion should be shared so as to make more people
ture (7.98 points), who believed in acupuncture (7.77 choose acupuncture for smoking cessation.
points), who was older than 61 years old (7.76 points),
who smoked 1-10 cigarettes per day (7.69 points) and Popularization of acupuncture knowledge to elderly
who owns college diploma or above (7.55 points). It is and young people
speculated that if a smoker complies with more ele- According to the thematic household survey report
ments above, smoking cessation will be easier to No. 53 8 made by Hong Kong government, more than
achieve by acupuncture. 50% of ex-smokers in Hong Kong were older than
60 years old. Subjects enrolled in this project were
Acupuncture for smoking cessation is more popular mainly aged 31-50 years old. Subjects older than 61
in female smokers years had the lower FTND, CO level and the highest
Currently, the number of female smokers in Hong confidence index, indicating that acupuncture for
Kong has grown from 56 100 1990 to 96 800 in 2012, smoking cessation in these people may be easy to

JTCM | www. journaltcm. com 638 October 15, 2016 | Volume 36 | Issue 5 |
 Wang YY et al. / Clinical Study

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JTCM | www. journaltcm. com 639 October 15, 2016 | Volume 36 | Issue 5 |