Effects of different smoking cessation regimens with acupuncture and their influence factors: a multi-center randomized controlled trial
(2.Exchange and Cooperation Center of TCM toward Taiwan, Hong Kong and Macao, National Administration of TCM, Beijing 100027)
(3.China-Japan Friendship Hospital)
(4.Wangjing Hospital of China Academy of Chinese Medical Sciences)
(5.Jintan District TCM Hospital of Changzhou City, Jiangsu Province)
(6.China Association of Acupuncture-Moxibustion)
(7.Beijing Haidian Hospital)
(8.Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700)
【Abstract】 Objective To evaluate the clinical effect of acupuncture on smoking cessation and abstinence symptoms and to explore the influence factors of acupuncture on smoking cessation. Methods A total of 500 subjects with tobacco dependence were randomly divided into the acupuncture group, the auricular point group, the acupuncture plus auricular point group, the transcutaneous electrical nerve stimulation group (TENS group), and the nicotine replacement therapy group (NRT group), 100 cases in each group. In the acupuncture group, needles were inserted at Baihui (GV20), Lieque (LU7), Hegu (LI4), Zusanli (ST36) and other points. The treatment was given five times a week, once a day in the first two weeks; while three times a week, once every 2 d in the 3rd to 4th weeks; twice a week, once every 3 d in the 5th to 8th weeks. In the auricular point group, the auricular pressure therapy was used at Shenmen (TF4), endocrine (CO18), subcortex (AT4), and sympathia (AH6a), three times a week. In the acupuncture + auricular point group, acupuncture and auricular pressing therapy were both adopted with the same points and manipulation as the previous two groups. Acupuncture was given three times a week and the auricular therapy was given twice a week. In the TENS group, SDZ-Ⅱ B type electric acupuncture apparatus was used to stimulate Lieque (LU7) and Zusanli (ST36), once a day. In the NRT group, the nicotine patch was used on the chest, back and the upper arms of the subjects, once a day. Eight weeks was a course of treatment for every group, and one course was applied with 16 weeks of follow-up. The objective withdrawal rate of subjects in the five groups was evaluated by the level of urine cotinine after eight weeks of treatment and during the follow-up. The subjective withdrawal rate was evaluated by the self-report of subjects in the five groups after eight weeks of treatment and during the follow-up. The withdrawal effect, and scores of the Fagerström Test for Nicotine Dependence (FTND) and Heaviness of Smoking Index (HSI) were compared among groups. A total of 20 indicators were selected as the potential influence factors. With the 72 h objective withdrawal rate based on the content of urinary cotinine after eight weeks of treatment and during the follow-up as the dependent variable, the binomial Logistic regression analysis was applied to screen out the influence factors of therapeutic effect of acupuncture on smoking cessation. Results After eight weeks of treatment, the objective withdrawal rate of subjects among groups was NRT group > acupuncture plus auricular point group > auricular point group > acupuncture group > TENS group. During the follow-up, it was in the sequence of acupuncture + auricular point group > NRT group > acupuncture group > TENS group > auricular point group, but the difference was not statistically significant (P > 0.05). After eight weeks of treatment, the subjective withdrawal rate of subjects among groups was auricular point group > TENS group > acupuncture group > acupuncture + auricular point group > NRT group. During the follow-up visit, it was in the sequence of auricular point group > TENS group > acupuncture + auricular point group > acupuncture group > NRT group. The result in the auricular point group was better than all other four groups (P < 0.05). Except the lower FTND score of the acupuncture group when comparing with the auricular point group during the follow-up (P < 0.05), differences of FTND and HSI scores in each group were not statistically significant after eight weeks of treatment and during the follow-up (P > 0.05). The regression analysis showed that the factors, including nationality, educational background, drinking frequency, FTND score before treatment, HSI score before treatment and smoking cessation for physical reason of family members, were correlated significantly with the withdrawal result after 8-week treatment (P < 0.05), while the factors, such as education background, smoking age, pre-treatment FTND score and different therapeutic methods, were correlated significantly with the withdrawal result during the follow-up (P < 0.05). Conclusion Acupuncture combined with auricular therapy can effectively reduce nicotine dependence and smoking intensity and relieve abstinence symptoms. There are many factors that affect the withdrawal effect in smoking cessation. Hence, the influence factors in smoking cessation with acupuncture should be clearly determined so as to develop the individual regimen for smoking cessation, thus improving the clinical therapeutic effect of acupuncture on smoking cessation.
【Keywords】 Smoking cessation; auricular press therapy; acupuncture and moxibustion; influence factor; nicotine dependence; randomized controlled trial (RCT);
(Translated by JIA RM)
 National Health Commission of the people’s Republic of China. China Report on the Health Hazards of Smoking [M]. Beijing: People’s Medical Publishing House, 2012 (in Chinese).
 Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030 [J]. PLoS Med, 2006, 3 (11): e442. DOI: 10.1371/journal.pmed.0030442.
 Yang GH, Hu AG. Smoking control and China’s future: joint assessment report of Chinese and foreign experts on tobacco use and control [M]. Beijing: The Economic Daily Press, 2011 (in Chinese).
 Liu BQ, Peto R, Chen ZM, et al. Emerging tobacco hazards in China: 1. retrospective proportional mortality study of one million deaths [J]. BMJ, 1998, 317 (7170): 1411–1422.
 Wang YY, Liu Z, Wu Y, et al. Acupuncture for smoking cessation in Hong Kong: a prospective multicenter observational study [J]. Evid Based Complement Alternat Med, 2016, 2016: 2865831.
 Wang YY, Liu Z, Zhang O, et al. Effect of acupuncture treatment on smoking cessation in smokers from Hong Kong [J]. Chung I Tsa Chih Ying Wen Pan, 2016, 36 (5): 634–639.
 Liu Z, Yang JS, Wu Y, et al. Predictors for smoking cessation with acupuncture in a Hong Kong population [J]. Evid Based Complement Alternat Med, 2015, 2015: 189694.
 World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines [M]. Geneva: World Health Organization, 1992.
 Li SY. WHO standard Acupuncture Point Locations in the Western Pacific Region [M]. Beijing: People’s Medical Publishing House, 2010 (in Chinese).
 Heatherton TF, Kozlowski LT, Frecker RC, et al. The fagerström test for nicotine dependence: a revision of the fagerström tolerance questionnaire [J]. Br J Addict, 1991, 86 (9): 1119–1127.
 Zhang FF, Wang YY, Liu Z, et al. Analysis on the law of clinical acupoint selection in smoking cessation with acupuncture [J]. Shanghai Journal of Acupuncture and Moxibustion, 2016, 35 (2): 230–232 (in Chinese).
 Liu Z, Wang YY, Wu Y, et al. Modern literature study on smoking cessation with acupuncture [J]. Journal of Traditional Chinese Medicine, 2015, 56 (24): 2116–2120 (in Chinese).
 Wang YY, Yang JS, Zhang O, et al. Progress on the research of acupuncture for smoking cessation in foreign and domestic [J]. Chinese Acupuncture & Moxibustion, 2013, 33 (3): 285–288 (in Chinese).
 Kang JM, Jiang Y. Common methods for assessment of passive smoking exposure [J]. Journal of Hygiene Research, 2007, 36 (6): 781–784 (in Chinese).
 Liu Z, Wu Y, Yang JS, et al. Literature analysis of the reporting of outcome measurements in randomized controlled trials of smoking cessation [J]. Chinese Journal of Evidence-Based Medicine, 2015, 15 (6): 730–734 (in Chinese).
 Wetter DW, Cofta-Gunn L, Irvin JE, et al. What accounts for the association of education and smoking cessation? [J]. Prev Med, 2005, 40 (4): 452–460.
 Zhao J, Xu TM, Yue P, et al. Study on hindering and promoting factors of smoking cessation [J]. Occupation and Health, 2017, 33 (23): 3310–3313 (in Chinese).
 Liu LX, Yang Y, Wang JJ, et al. Quit attempt rate and its associated factors among Chinese adults smokers [J]. Chinese Journal of Health Education, 2018, 34 (5): 387–390 (in Chinese).
 Hou W, Wang CY. Using Logistic regressive model for analyzing factors of quitting smoking [J]. Journal of Mathematical Medicine, 2000, 13 (2): 162–163 (in Chinese).