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Background: Acupuncture combined with auricular acupressure has been used as a complementary and alternative treatment for smoking cessation in Hong Kong for over 10 years. This study aimed to verify its therapeutic effects and safety for smoking cessation and to evaluate its effects on tobacco dependence, smoking behavior, anxiety levels and sleep disturbances between successful and unsuccessful quit smokers in Hong Kong.Methods: This prospective, multicenter clinical study conducted between September 2020 and February 2022 in Hong Kong was part of the Guangdong-Hong Kong-Macau Greater Bay Area project on smoking cessation. Thirty eligible current smokers (mean age: 47.10 years; 40% female) were recruited and received standardized acupuncture plus auricular acupressure treatment twice weekly for 8 weeks. The primary outcome was the success rate of smoking cessation at week 24. The secondary outcomes were the success rate of smoking cessation at weeks 8 and 16, exhaled carbon monoxide (CO) level, changes in scores on the Fagerström Test for Nicotine Dependence (FTND), Autonomy Over Smoking Scale (AUTOS), Hamilton Anxiety Rating Scale (HAM-A), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI). Adverse events were also recorded during the study period.Results: Of 30, 28 participants completed 6 or more treatment sessions and all completed follow-up assessments. At week 24, the success rate of smoking cessation was 46.67%. The successful quit rates at weeks 8 and 16 were 36.67% and 43.33%, respectively. The overall change in mean FTND scores from baseline improved significantly from weeks 2 to 24 (P < 0.05), with the successful quit group showing significantly greater improvement between weeks 8 and 24 (P < 0.01). Compared with baseline, there were significant reductions in the mean AUTOS scores from weeks 6 to 24 (P < 0.001), with the successful quit group showing greater improvement at weeks 16 (P = 0.04) and 24 (P < 0.001). No significant changes were detected in exhaled CO levels and HAM-A, SAS, and PSQI scores. No study-related adverse events were observed.Conclusions: Acupuncture combined with auricular acupressure is an effective alternative treatment for smoking cessation and reducing tobacco dependence and cigarette consumption among Hong Kong smokers.Trial registration: Chinese Clinical Trial Registry, No. ChiCTR2000033650. Registered on June 7, 2020, http://www.chictr.org.cn/showproj.aspx?proj=54866