Pérez-Martín, HipólitoLidón-Moyano, CristinaGonzález-Marrón, AdriánFu, MarcelaPérez Ortuño, Raúl, 1976-Ballbé, MontseMartín-Sánchez, Juan CarlosPascual Esteban, José A.Fernández, EsteveMartínez-Sánchez, Jose M.2023-01-232022Pérez-Martín H, Lidón-Moyano C, González-Marrón A, Fu M, Pérez-Ortuño R, Ballbè M, et al. Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation. Cancer Epidemiol. 2022 Oct; 80: 102226. DOI: 10.1016/j.canep.2022.102226.1877-7821http://hdl.handle.net/10230/55372Introduction: 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.application/pdfeng© Elsevier http://dx.doi.org/10.1016/j.canep.2022.102226info:eu-repo/semantics/articlehttp://dx.doi.org/10.1016/j.canep.2022.102226BiomarkerCotinineCutoff valueSmoking statusTobaccoinfo:eu-repo/semantics/openAccess