For those who want to quit smoking, acupuncture directed to selected points in the body may help curb the desire to smoke, according to a report in the journal Preventive Medicine (Vol. 33: 364-372).

Acupuncture is a technique in which very thin needles of varying lengths are inserted through the skin to treat a variety of conditions. Acupuncture originated 2,000 to 3,000 years ago and is an important component of current traditional Chinese medicine.

In this study, 46 participants were followed for five years. Twenty-six people were given acupuncture treatment at points selected to affect smoking-related organs such as the lungs, airways, and mouth. The 20 participants in the control group (used for comparison) received acupuncture at points that were related to skeletal and muscular systems assumed not to have any effect on smoking.

The participants in the test group who were given the strategically placed treatment reported smoking less and had a decreased desire to smoke. In addition, the blood levels for smoking-related chemicals were lower for this group than in the control group up to eight months after treatment.

The control group received no lasting effect from the treatment they were given in terms of reducing their smoking or desire to smoke.

Researchers asked the participants how many cigarettes they smoked. In addition, they measured participants' blood for the concentration of two chemicals: cotinine and thiocyanate, said lead author He Dong, MSc, physiologist and acupuncturist at the Institute of General Practice and Community Medicine at the University of Oslo, Norway.

"The cotinine concentration reflects the smoking during the last few days," said He. "The thiocyanate concentration reflects the smoking during the last two to three weeks before the sample is taken."

"Thus, by measuring both parameters we got an independent measure of the honesty or possible dishonesty in the subjects' reported smoking," said He.

The average length of time the participants had smoked was 23 years, with an average of 10 to 30 cigarettes a day. All participants wanted to quit, and all agreed to use no other form of smoking cessation during the three-week treatment period. Participants were not told which group they were in.

He and her co-authors found that among the participants in the test group about a third of them had cotinine concentration similar to that of non-smokers, both right after treatment and again eight months later. Cotinine levels were not measured at the five-year point.

After five years, four participants in the test group had quit smoking compared with two in the control group.

For both groups, the acupuncture consisted of body electroacupuncture, ear acupuncture, and ear acupressure. The participants were instructed to perform their own ear acupressure four times a day, according to the article.

The authors wrote that it is important for acupuncture to be adequate. Both groups received treatments twice a week, for three weeks — a total of six treatments, in addition to the self-administered ear acupressure.

"A trained acupuncturist should be able to reproduce the treatment from our description," He said. "We used treatments on acupoints that are known to affect organs directly influenced by tobacco smoke like the mouth, throat, airways, and lungs."

She said the participant ought to be able to feel an effect.

"It is a widespread experience that if the treatment is effective, the patient will note an effect during the first three treatments," said He. "If a patient does not feel any changes after three treatments, he or she should discuss [that] with the acupuncturist."

Two components of the study were important: a long follow-up period and the use of periodic blood tests for an objective measure of whether participants were smoking, said noted tobacco control expert, Alan Henderson, DrPH, professor at California State University, Long Beach and a past president of California's division of the American Cancer Society (ACS).

"All too often, participants in studies inadvertently report compliance to support the study while in some state of non-compliance," said Henderson, who recently was appointed to a committee for tobacco education by California Gov. Gray Davis. "Wherever possible the methods used by [these] authors should be included in cessation studies."

One of the major drawbacks of this study was the fairly small number of participants, and further studies will be needed to confirm these results, Henderson said. But the five-year followup was ambitious, he said.

Still, the long period brings up the question of what other social factors during those five years might have affected the participants. For example, what kind of support or discouragement did these participants get from the people and regulations around them?

This acupuncture study measured not just quitting, but also the reduction of smoking. Henderson said this approach raises the issue of whether reducing smoking is a worthwhile goal rather than focusing only on getting smokers to quit.

"We know … those who smoke more, for longer, have more tobacco-related diseases than those who smoke less, for a shorter period," Henderson said. "And those who don't smoke at all have significantly less disease."

Henderson said that the authors noted that the actual treatment has varied in past studies that included acupuncture. This, he said, points out the need to establish minimum criteria for treatment that has a therapeutic effect.