Tobacco exposure associated with oral microbiota oxygen utilization in the New York City Health and Nutrition Examination Study

Ann Epidemiol. 2019 Jun;34:18-25.e3. doi: 10.1016/j.annepidem.2019.03.005. Epub 2019 Mar 28.


Purpose: The effect of tobacco exposure on the oral microbiome has not been established.

Methods: We performed amplicon sequencing of the 16S ribosomal RNA gene V4 variable region to estimate bacterial community characteristics in 259 oral rinse samples, selected based on self-reported smoking and serum cotinine levels, from the 2013-2014 New York City Health and Nutrition Examination Study. We identified differentially abundant operational taxonomic units (OTUs) by primary and secondhand tobacco exposure, and used "microbe set enrichment analysis" to assess shifts in microbial oxygen utilization.

Results: Cigarette smoking was associated with depletion of aerobic OTUs (Enrichment Score test statistic ES = -0.75, P = .002) with a minority (29%) of aerobic OTUs enriched in current smokers compared with never smokers. Consistent shifts in the microbiota were observed for current cigarette smokers as for nonsmokers with secondhand exposure as measured by serum cotinine levels. Differential abundance findings were similar in crude and adjusted analyses.

Conclusions: Results support a plausible link between tobacco exposure and shifts in the oral microbiome at the population level through three lines of evidence: (1) a shift in microbiota oxygen utilization associated with primary tobacco smoke exposure; (2) consistency of abundance fold changes associated with current smoking and shifts along the gradient of secondhand smoke exposure among nonsmokers; and (3) consistency after adjusting for a priori hypothesized confounders.

Keywords: 16S; Human microbiome; Microbiota; Oral health; RNA; Ribosomal; Smoking; Tobacco.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Cotinine / blood*
  • Female
  • Humans
  • Male
  • Microbiota*
  • Mouth / microbiology*
  • New York City / epidemiology
  • RNA, Ribosomal, 16S / genetics
  • Saliva / chemistry*
  • Tobacco Smoke Pollution / analysis*
  • Tobacco Smoking / blood*


  • Biomarkers
  • RNA, Ribosomal, 16S
  • Tobacco Smoke Pollution
  • Cotinine