Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation. (October 2022)

• Record Type: Journal Article
• Authors: Pérez-Martín, Hipólito; Lidón-Moyano, Cristina; González-Marrón, Adrián; Fu, Marcela; Pérez-Ortuño, Raúl; Ballbè, Montse; Martín-Sánchez, Juan Carlos; Pascual, José A.; Fernández, Esteve; Martínez-Sánchez, Jose M.
• Is Part Of: Cancer epidemiology. Volume 80(2022)
• Publication Date: 2022-10
• Subjects: biomarker -- cotinine -- cutoff value -- smoking status -- tobacco; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2022.102226
• Languages: English
• ISSNs: 1877-7821

Abstract

Abstract: Introduction: High levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. Methods: This longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. Results: The mean salivary cotinine concentration was significantly lower post-2010 law (−85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. Conclusion: The implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population. Graphical Abstract: ga1 Highlights: Cotinine cut-offs have changed after implementing smoke-free legislation in Spain. The cut-off point to discriminate smokers from nonsmokers decreased by near 86%. Spanish smoke-free legislation was effective reducing secondhand smoke exposure.