Laser Acupuncture for Adolescent Smokers—A Randomized Double-Blind Controlled Trial

American Journal of Chinese Medicine, Summer-Fall, 2000 by Cai Yiming, Zhao Changxin, Wong Song Ung, Zhang Lei, Lim Seuk Kean

Abstract: A double blind, randomized, placebo-controlled clinical study was conducted to evaluate the efficacy of laser acupuncture treatment in adolescent smokers. Three hundred and thirty adolescent smokers at the Smoking Cessation Clinic of Child Guidance Clinic, Institute of Health, Singapore, were randomly assigned in equal numbers to laser acupuncture treatment and sham acupuncture (control) groups. The proportions of patients with complete smoking cessation after completing treatment for four weeks were 21.9% in the treatment group and 21.4% in the control group. At three months post-treatment, the rates for complete cessation were 24.8% and 26.2%, respectively. Thus, there was no significant difference in the rates of smoking cessation in the treatment and control groups.

The 1994 report of the US Surgeon General (Elders et al., 1994), the first such report to focus on young smokers, reached six major conclusions:

(1) Nearly all first use of tobacco occurs by age 18.

(2) Most adolescent smokers are addicted to nicotine.

(3) Tobacco is often the first drug used by young people who subsequently use illegal drugs.

(4) There are identified psychosocial risk factors for the onset of tobacco use.

(5) Cigarette advertising also appears to increase young people's risk of smoking.

(6) Community-wide efforts have successfully reduced adolescent use of tobacco.

Cigarette smoking is well recognized as difficult to treat since addiction to tobacco is very strong and a nicotine withdrawal syndrome may follow smoking cessation. Smoking cessation treatments generally require time, effort and other resources. The cost of such treatment is, therefore, an important consideration. Acupuncture treatment is simple, economical and without untoward reactions. There are numerous reports suggesting that acupuncture is effective in treating smoking in adults. There are several methods used including body acupuncture, ear acupuncture, laser acupuncture and auricular point sticking (Cui et al., 1992 & 1993; Gilbey et al., 1977; Jiang et al., 1994; Parker et al., 1977; Tan, 1990).

In a review of 64 publications by Jiang, the overall efficacy was 84.0% as measured immediately post-treatment (Jiang et al., 1994). Most of these studies, however, have design shortcomings, such as lack of a placebo control, small sample size, and the outcome measurement being non-blind. In the absence of a placebo control group, it is clearly not possible to remove the psychological bias on the outcome.

Swartz reviewed 30 reports of acupuncture treatment for smoking cessation (Swartz, 1992). He suggested that the reported efficacy of acupuncture was possibly due to a placebo effect. Swartz also reviewed 11 reports of controlled studies. Two showed a significant difference between treatment and control group (p [is less than] 0.05). The remaining nine showed no significant difference, with three actually showing a better outcome in the placebo group. Swartz suggested that the effect of acupuncture is psychological. The weakness of the latter nine studies is that there was no standardization of the intensity of stimulation applied to the acupoints nor were the same acupoints used for the treatment and control groups.

Recently, laser acupuncture has been widely used in medical treatments. It has several advantages, particularly in saving time and not causing pain or inflammation. It is simple, safe and with no side effects, while the intensity of the laser can be adjusted. It is readily acceptable to patients.

Tan conducted an acupuncture treatment study of 418 adult smokers in Singapore concluding that laser acupuncture was highly effective (Tan, 1990). He divided his subjects into various subgroups (of 10 to 42 subjects), each involving different acupoints (or group of acupoints), and differing intensities of stimulation and differing durations. He concluded that the most effective treatment group (defined as a 50% reduction or more in the number of cigarettes smoked a day) emerged from the group that received laser on the ear points, and where there was an eighty per cent response.

Zhang subjected 31 smokers to laser acupuncture on auricular points without the subjects' knowledge, during treatment sessions for other conditions (Zhang, 1994). He claimed there was positive effect on smoking control and that the effect was not due to psychological factors. However, he did not use any control group, and the sample size (N=31) was too small to be conclusive.

Reports of using laser acupuncture treatment for smoking is not uncommon. From our knowledge, there is no report of smoking cessation using laser acupuncture in adolescents. The aim of this study was to determine if laser acupuncture is effective in the treatment of adolescent smokers, and to use a methodology that would redress shortcomings of previous studies.

Subjects and Methods

Subjects

Three hundred and thirty young smokers, aged 12 to 18, with at least three months of smoking experience and a minimum of five cigarettes smoked a day were invited to participate in the study as an alternative to the counseling workshop. The study had the approval of the Ethical Committee of Woodbridge Hospital.