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. Author manuscript; available in PMC: 2023 Feb 1.
Published in final edited form as: Addict Behav. 2021 Nov 23;126:107184. doi: 10.1016/j.addbeh.2021.107184

The impact of cigarette pack anti-littering messages

Jennifer C Morgan a,b,*, Michelle Jeong a,c, Jennifer Mendel-Sheldon a,d, Seth M Noar d,e, Kurt M Ribisl a,d, Noel T Brewer a,d
PMCID: PMC8893237  NIHMSID: NIHMS1780506  PMID: 34906881

Abstract

Objective:

Tobacco butts are the most littered item worldwide and pose a critical environmental and public health hazard. Given the positive impact of required graphic warnings on smoking, we sought to assess the impact of a policy requiring cigarette pack anti-littering messages on smokers’ littering intentions.

Methods:

We randomly assigned US adult smokers (n = 719) to receive labels on the side of their cigarette packs for three weeks: anti-littering messages or messages about chemicals in cigarette smoke.

Results:

Anti-littering messages elicited higher intentions to refrain from littering in the next month compared to chemical messages (p < .05). Anti-littering messages also led to increased knowledge about cigarette butts being the most common form of litter, the number of conversations about littering, and thinking about the proper disposal of cigarettes (all p < .05). Finally, smoking from packs labeled with anti-littering messages led to fewer weeks littering from car windows compared to packs labeled with chemical messages (p < .05), but did not affect completely refraining from littering cigarette butts. Mediators of the messages’ impact on littering intentions were thinking about proper cigarette butt disposal and perceived message effectiveness (both p < .05).

Conclusions:

Policies requiring anti-littering messages on cigarette packs would raise awareness about the problem of cigarette butt litter and bolster intentions to not litter.

Keywords: Litter, Environmental communication, Labeling, Cigarette butts, Cigarettes, Clinical trial

1. Introduction

Tobacco butts are the most littered item worldwide and pose a critical environmental hazard (Novotny and Slaughter, 2014; Castaldi et al., 2020). Non-biodegradable cigarette filters—the cigarette butts—accumulate to become toxic waste and the toxic substances within cigarettes contaminate soil, pollute the waterways, and harm aquatic wildlife (Novotny and Slaughter, 2014; Barnes, 2011; Roder Green et al., 2014). Tobacco butt litter also presents a public health threat to both humans (especially young children) and animals via accidental consumption (Novotny et al., 2011). Public concern about environmental issues like environmental toxins, plastic use and pollution, and contaminated water is increasing, providing a window of opportunity to address the problem of tobacco butt litter.

Globally, six trillion cigarettes are smoked every year and 75% of the butts are littered. Roughly, this equates to nearly one billion kilograms of littered non-biodegradable toxic filters (Novotny and Slaughter, 2014; Proctor, 2012). In the US, littered tobacco products make up over a third of all roadway litter (Schultz, 2009) and a substantial portion of litter in parks, beaches, and rivers (Smith and McDaniel, 2011). The small size of cigarette butts makes the monitoring and cleaning operations used for other types of litter more costly and often ineffective (Castaldi et al., 2020).

1.1. Influences on littering behaviors

Individual, social, environmental, and policy factors all influence littering behaviors (Al-mosa et al., 2017). Individuals’ beliefs and attitudes, including that cigarette butts are litter, motivate cigarette butt littering behavior (Schultz, 2009; Rath et al., 2012). Current smokers are responsible for the littering problem, but they are much less likely than never and former smokers to believe that cigarette butts are litter (Rath et al., 2012). Almost a quarter of people do not believe cigarette butts are toxic and believe that cigarette butts are biodegradable; compared to never and former smokers, current smokers believe that cigarette butts are less toxic and more likely to be biodegradable. This highlights the need for increasing public awareness and an opportunity to change beliefs regarding cigarette butt littering in order to reduce littering behavior (Rath et al., 2012). Littering is also a socially driven behavior affected by social norms for and against littering. For example, people are more likely to litter if they see someone else littering and if they are in an area with litter on the ground already (Novotny et al., 2011; Cialdini et al., 1990). The built environment plays a role in littering behavior too. Previous studies have attributed cigarette butt littering to structural issues, such as a lack of receptacles (e.g., ashtrays) in convenient locations that provide a place to butt out cigarettes (Novotny and Slaughter, 2014; Schultz et al., 2013).

Enacting effective policies targeting these factors can successfully reduce tobacco littering. Policies that ban and institute fines are two traditional ways to reduce litter. Unfortunately, they have proved to have a limited impact in reducing the number of littered cigarette butts. Bans prohibiting plastic straws are growing in popularity as a way to addressing plastic pollution (Rainey, 2018; Rainey, 2018). Given the environmental impact of littered plastic cigarette butt filters, politicians have tried introducing legislation banning filters, or offering rebates for butts returned to redemption centers, however, these efforts have not had success to date (Rainey, 2018). The combination of limited success reducing tobacco butt littering with traditional littering policies and unsuccessful efforts with policies specifically designed to target the tobacco butt littering problem make this a serious challenge for policymakers.

1.2. Message effects

Addressing the problem of tobacco butt littering will require changes in both policy and individual behavior. Increasing public support for policies aimed at reducing tobacco butt litter is one way to increase the chances of proposed policies being enacted. Effective messages have been shown to affect policy support (Druckman and Leeper, 2012; Niederdeppe et al., 2015); social norms (Yanovitzky and Stryker, 2001); and individual behavior (Wakefield et al., 2010).

Media campaigns that include anti-littering messages are one way to reach and persuade the general public to stop littering (Huffman et al., 1995). While there have been some campaigns targeting the littering of cigarette butts specifically (i.e. the American Legacy Foundation “Rethink Butts” campaign), evaluation of their impact on reducing cigarette butt litter is lacking. Furthermore, few studies have examined message strategies in the context of cigarette butt littering.

Some cigarette packs have anti-littering messages, but there is no standard policy requiring them or specifying their characteristics. Messages on cigarette packs have the advantage of specifically targeting smokers and repeatedly exposing them to the message. Graphic warnings on cigarette packs successfully communicate health information to smokers and lead to quitting (Centers for Disease Control and Prevention, 2009). This suggests an opportunity to understand if different pack messages can change other behaviors. Thus, we sought to evaluate whether participants smoking from packs with anti-littering messages had higher intentions to refrain from littering compared to those who smoked from packs with chemical messages. We also examined whether people smoking from packs with the anti-littering messages would have higher ratings of perceived message effectiveness (Dillard et al., 2007); more conversations about littering (i.e. social interactions) (Brewer et al., 2018; Morgan et al., 2018), and report more thinking about littering (i.e. cognitive elaboration) compared to participants smoking from packs with chemical messages (Brewer et al., 2018; Morgan et al., 2018; Petty and Cacioppo, 1986). Prominent theories of health behavior and message effects posit that these three constructs all reflect greater engagement with the messages, which should make them more effective and increase the impact of policies requiring anti-littering pack messages.

2. Methods

2.1. Overview

This paper reports results from a clinical trial in which current smokers received anti-littering messages or chemical messages on the side of their cigarette packs for three weeks (clinicaltrials.gov identifier: NCT02785484). The trial was designed to assess the impact of the chemical messages on intentions to quit smoking with anti-littering messages serving as control (Brewer et al., 2019). During the trial, we also assessed littering behavior, allowing us to compare the impact of anti-littering and chemical messages on intentions to refrain from littering cigarette butts, which is the focus of the current paper.

2.2. Participants

We recruited a convenience sample of adult smokers from the California Bay Area in the United States from September 2016 to March 2017. Eligibility criteria were: being age 21 years or older; being a current smoker (defined as having smoked at least 100 cigarettes and currently smoking every day or some days) (Jamal et al., 2016); smoking at least seven cigarettes per week (to exclude very light smokers who might not purchase their own packs); being able to attend five weekly appointments; being able to bring in 8 days’ worth of cigarettes to each of the first four weekly visits; and being able to speak English and use a computer to take surveys. We excluded pregnant women from the trial, smokers who used only roll-your-own cigarettes, were concurrently enrolled in another tobacco study, or lived in the same household as another trial participant. We recruited participants using craigslist, Facebook, in-person recruitment, and newspaper advertisements. Participants were 368 men, 320 women, and 31 transgender people. Their mean age was 42.4 years (range 21–79). Trial participants were diverse in race, sexual orientation, education, and income; participant characteristics did not differ by intervention arm (Table 1).

Table 1.

Participant characteristics.

Anti-littering
message arm
(n = 359)
n (%)		 Chemical message
arm
(n = 360)
n (%)
Mean age (SD) 42.8 (13.6) 42.1 (13.2)
Age in years
 21–29 81 (22.6) 83 (23.1)
 30–39 86 (24.0) 78 (21.7)
 40–49 59 (16.4) 75 (20.8)
 50–59 90 (25.1) 91 (25.3)
 60+ 43 (12.0) 33 (9.2)
Gender
 Male 172 (47.9) 196 (54.4)
 Female 169 (47.1) 151 (41.9)
 Transgender (includes other gender identity) 18 (5.0) 13 (3.6)
Gay, lesbian, or bisexual 88 (24.5) 93 (25.8)
Hispanic 56 (15.6) 44 (12.2)
Race
 White 136 (37.9) 132 (36.7)
 Black or African American 124 (34.5) 133 (36.9)
 American Indian or Alaska Native 17 (4.7) 17 (4.7)
 Asian 29 (8.1) 31 (8.6)
 Native Hawaiian or other Pacific Islander 11 (3.1) 12 (3.3)
 Other/multiracial 42 (11.7) 35 (9.7)
Education
 High school graduate or less 67 (18.7) 89 (24.7)
 Some college 151 (42.1) 124 (34.4)
 College graduate 114 (31.8) 122 (33.9)
 Graduate degree 27 (7.5) 25 (6.9)
Low income, <200% of federal poverty level 197 (54.9) 216 (60.0)
Daily smokers 273 (76.0) 281 (78.1)
Cigarettes smoked per day, mean(SD) 9.97 (12.2) 11.62 (16.9)
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Note. Unless otherwise noted, data are reported as the number (percentage) of participants. Participant characteristics and outcomes at baseline did not differ by trial arm (all p > .05).

2.3. Procedures

Participants attended five visits, each one week apart, at the trial office. Smokers brought in an eight-day supply of cigarettes to Visits 1–4. At Visit 2, participants were randomly assigned to have their cigarettes labeled with either an anti-littering message or a message about chemicals in cigarette smoke. The messages were applied to the side of their cigarette packs over the US Surgeon General’s warning. In both conditions, the labels were matched on layout, size, and color (Fig. 1). Participants received a new label, in random order, at Visits 2, 3, and 4, for a total of three different messages during the trial.

Fig. 1.

Fig. 1.

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Labels placed on smokers’ cigarette packs in the trial arms.

Participants completed computer surveys at the baseline visit (Visit 1) and each subsequent weekly visit (Visits 2–5). While participants completed the surveys, research staff placed the assigned labels on participants’ cigarette packs following a standardized protocol (Brewer et al., 2016). At the end of each visit, upon completion of the survey, participants received cash incentives that totaled up to $300 across the trial ($75 at Visit 1; $50 at Visit 2; $50 at Visit 3; $50 at Visit 4; $75 at Visit 5). Additional details about the trial design appear in the main trial paper, which focused on the impact of the chemical messages (Brewer et al., 2019). The University of North Carolina institutional review board approved the trials procedures.

2.4. Measures

The surveys used items previously validated in prior studies and some newly developed survey items that we cognitively tested with adult smokers either in-person (n = 7) or online through Amazon Mechanical Turk (n = 311) (Willis, 2004). The Visit 1 survey assessed demographic characteristics, while the Visit 2–5 surveys asked about littering behavior, number of conversations about littering, thinking about littering, and intentions to litter. The Visit 5 survey also asked about knowledge of cigarette butt litter and the perceived effectiveness of the labels. Study staff labeled cigarette packs after participants completed the Visit 2 survey, therefore participants completed surveys for Visits 3, 4, and 5 after smoking from the labeled packs.

Intention to refrain from littering.

The survey assessed intentions to litter with the item, “How likely are you to dispose of your cigarette butts by dropping them on the ground in the next month?” The 4-point response scale was “not at all likely” (coded as 1), “a little likely” (coded as 2), “somewhat likely” (coded as 3), and “very likely” (coded as 4). To capture intentions to litter after smoking from the trial’s labeled packs we averaged responses to this item assessed at Visits 3–5 and then reversed coded it so that higher values indicated an intention to refrain from littering.

Littering behavior.

The survey assessed two types of littering behavior: “Many people smoking outdoors dispose of their cigarette butts by dropping them on the ground. In the last week, did you dispose of your cigarettes in this way?” and “Many people smoking in their cars dispose of their cigarette butts by throwing or dropping them out the car window. In the last week did you dispose of your cigarettes in this way?” To characterize completely refraining from littering behavior while smoking from the labeled packs, we coded participants who answered “no” to both items while smoking from labeled packs (Visits 3–5) as having not littered during the trial. To measure the frequency of littering behavior during the trial, we added the number of weeks participants reported disposing of cigarettes on the ground or out the car window, ranging from 0 to 3 weeks.

Conversations about littering.

The survey assessed the frequency of conversations about the labels with one item, “In the last week, how many times did you talk to others about discarding cigarette butts properly?” The averaged responses to this item assessed at Visits 3–5 created a score for conversations about littering while smoking from labeled packs.

Thinking about littering.

The survey assessed thinking about littering (i.e. cognitive elaboration) with the item, “In the last week, how much did you think about discarding cigarette butts properly?” The 5-point response scale ranged was “never” (coded as 1), “rarely” (coded as 2), “sometimes” (coded as 3), often (coded as 4), and “all the time” (coded as 5). The averaged responses to this item assessed at Visits 3–5 created a score for thinking about littering while smoking from labeled packs.

Knowledge.

The Visit 5 survey assessed knowledge about littering with two items, “Are you aware that cigarette filters are the most common kind of litter?” and “Are you aware that cigarette butts do not biodegrade?” We coded “yes” responses as knowing these facts.

Perceived message effectiveness.

The Visit 5 survey assessed perceived effectiveness with the item, “The labels discourage me from disposing of cigarette butts by dropping them on the ground.” The 5-point response scale was “strongly disagree” (coded as 1) “somewhat disagree” (coded as 2), neither agree nor disagree (coded as 3), somewhat agree (coded as 4), and “strongly agree” (coded as 5).

2.5. Statistical analysis

Intent-to-treat analyses included all participants who were randomized to a condition (n = 719). We examined whether outcomes differed by trial arm using χ2 tests for categorical variables and t-tests for continuous variables, and Mann-Whitney U tests for ordinal variables. Analyses used the last observation available carried forward. A multiple mediator model examined whether statistically significant psychosocial variables explained the impact of anti-littering messages on intentions not to litter. While the trial was powered to detect a difference in quit intentions, we did not conduct an a priori power analysis for littering outcomes. Analyses used two-tailed tests and a critical alpha of 0.05, in SAS v. 9.4 (SAS, 2004) for the main analyses and and ML estimator in MPLUS v. 8.0 (Muthén and Mplus, 2017) for the mediation analysis. We report mediated pathways as standardized regression coefficients (μs).

3. Results

Smokers who received anti-littering messages had higher intentions to refrain from littering than smokers who received chemical messages (mean [SD] = 2.99 [0.97] vs. 2.79 [1.09], p < .01) (Table 2). Anti-littering messages led to littering by dropping cigarette butts out of the car window for fewer weeks compared to participants with chemical pack messages (mean [SD] = 0.50 [0.92] vs. 0.69 [1.12], p < .01). The anti-littering pack messages did not affect the behavior of completely refraining from littering cigarette butts while smoking from labeled packs.

Table 2.

Littering outcomes at end of the trial, intent-to-treat analysis.

Items Anti-littering message arm
(n =359)		 Chemical message arm
(n =360)		 % Difference (95% CI) Test statistic
Effect size		 P
n % n %
Littering behavior
 Did not litter while smoking from labeled packs 359 39.3 360 36.4 2.89 (−4.33–9.99) Pearson chi2 = 0.64
Phi = 0.03		 0.43
Knowledge that
 Cigarette butts are the most common littera 351 66.4 353 52.4 13.97 (6.77–21.18) Pearson chi2 = 14.25
Phi = 0.14		 <0.01
 Cigarette butts do not biodegradea 351 68.1 353 48.4 19.65 (12.49–26.81) Pearson chi2 = 27.94
Phi = 0.20		 <0.01
Mean (SD) Mean (SD) Difference (95% CI)
Littering behavior
 No. of weeks cigarette butts disposed on ground 359 1.38(1.32) 360 1.54 (1.34) −0.16 (−0.36–0.03) t= −1.63
Cohen’s d = −0.12		 0.10
 No. of weeks cigarette butts disposed out car window 359 0.50 (0.92) 360 0.69 (1.12) −0.19 (−0.34 to −0.04) t= −2.49
Cohen’s d = −0.19		 0.01
Littering intentions
 Intention to refrain from littering cigarette buttsb,c 359 2.99 (0.97) 360 2.79 (1.09) 0.20 (0.05–0.35) z = −2.16
Cohen’s d = −0.20		 0.03
Social interactions
 No. of conversations about litteringb 355 2.04 (4.26) 354 1.45 (3.55) 0.59 (0.01–1.17) t = 2.01
Cohen’s d = 0.15		 0.04
Cognitive elaboration
 Thought about disposing of cigarette butts properlyb,d 359 3.50 (1.20) 360 3.23 (1.30) 0.27 (0.09–0.46) z = 2.74
Cohen’s d = 0.22		 <0.01
Perceived message effectiveness
 Agreement that labels discouraged litteringa,d 348 3.61 (1.44) 350 2.89 (1.41) 0.72 (0.51–0.93) z = 6.70
Cohen’s d = 0.51		 <0.01
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Note. CI = confidence interval.

a

The knowledge and perceived message effectiveness items were only assessed at visit 5 follow-up, resulting in more missing data than for other variables. Missing data ranged from 0% to 2.8%.

b

Mean scores for all weeks with labeled packs.

c

Response scale ranged from 1 to 4, with 4 indicating higher intentions to not litter.

d

Response scale ranged from 1 to 5, with 5 indicating higher quantity or stronger endorsement.

Participants smoking from packs with anti-littering messages demonstrated more knowledge that cigarette filters are the most common form of litter (66% anti-litter message vs. 52% chemical message, p .01) and that cigarette butts do not biodegrade (68% vs. 48%, p < .01) (Table 2). Anti-littering messages led to more conversations about not littering cigarette butts (p = .04) and thinking about disposing of them properly (p < .01) compared to chemical messages. Smokers perceived the anti-littering messages to be more effective at discouraging littering than the chemical messages (p < .01).

The largest mediation effect was for thoughts about littering (βa*βb = 0.05 [95% CI 0.02–0.08], Table 3). Anti-littering messages led to increased thinking about disposing of cigarette butts correctly (βa = 0.11, p < .05) compared to chemical messages, which in turn was associated with higher intentions to refrain from littering (βb = 0.46, p < .05). The mediation effect for perceived message effectiveness was somewhat smaller (βa*βb = 0.03 [95% CI 0.004–0.05]). Smokers exposed to anti-littering messages reported higher perceived discouragement from littering (βa = 0.25, p < .05) compared to chemical messages, which in turn was associated with higher intentions to refrain from littering (βb = 0.10, p < .05).

Table 3.

Mediators of the impact of exposure to anti-littering messages on littering intentions (n = 719).

Mediation pathways β a β b Mediated effect
βa*βb(95% CI)
Anti-littering message →Knowledge that filters are the most common litter →Littering intentions 0.14* −0.02 −0.00 (−0.01–0.01)
Anti-littering message →Knowledge that cigarette butts do not biodegrade →Littering intentions 0.20* 0.02 0.01 (−0.01–0.02)
Anti-littering message →No. of conversations about littering →Littering intentions 0.08* −0.08* −0.01 (−0.01–0.002)
Anti-littering message →Thought about disposing of cigarette butts properly →Littering intentions 0.11* 0.46* 0.05* (0.02–0.08)
Anti-littering message →greed that labels discouraged littering →Littering intentions 0.25* 0.10* 0.03* (0.004–0.05)
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Note. The table reports standardized path coefficients (β’s) for the multiple mediator model. βa represents the path from the anti-littering message to the mediator. βb represents the path between the mediator and littering intentions.

*

p < .0

4. Discussion

Some cigarette packs have voluntary messages that discourage littering, but the U.S. does not require or mandate these pack messages. In our field trial of messages on smokers’ cigarette packs, anti-littering messages led to higher intentions to refrain from littering cigarette butts and fewer numbers of weeks participants littered cigarette butts out car windows compared to participants smoking from packs with chemical messages. Compared to chemical messages, the anti-littering messages led to more knowledge that cigarette butts are the most littered item in the U.S. and are not biodegradable. Fewer weeks littering from car windows, more knowledge and higher behavioral intentions suggest that policies requiring anti-littering messages may effectively inform smokers and motivate behaviors that may reduce cigarette butt litter. Indeed, prior research demonstrates that changes in intentions can lead to behavioral changes (Webb and Sheeran, 2006). Thus, policies requiring littering messages on packs may serve the government’s interests of informing the public as well as motivating the public not to litter.

Understanding the mechanisms through which anti-littering messages about cigarette butts work is an important contribution made by our trial. Anti-littering messages caused more thinking about littering, talking about littering, and higher perceptions that the messages were effective at discouraging littering. Furthermore, a mediation analysis found that thinking about disposing of cigarette butts correctly and perceiving the messages as effective explained the messages’ impact on intentions. Talking about littering did not mediate littering intentions. This is in contrast to prior research that has found that talking mediates the relationship between pictorial warnings and quit attempts (Morgan et al., 2018). This suggests that perhaps littering is not a social topic like smoking cessation. Thinking about the message appears to be a key mechanism through which the messages are influencing behavior. This supports prior research that other pictorial warning labels are effective because it keeps a topic on your mind (Brewer et al., 2018; Morgan et al., 2018). These constructs are important elements in the Elaboration Likelihood Model (ELM) and the Theory of Reasoned Action (TRA) which seek to explain the processes involved in behavioral change (Petty and Cacioppo, 1986; Madden et al., 1992). The anti-littering messages led to higher perceived effectiveness, more social interactions, and higher cognitive elaboration about the message (ELM), and lower intentions to litter (TRA).

Some products like aluminum cans, bottles, and plastics have messages printed on their packaging advising consumers to not litter the products or packages. However, the U.S. does not currently require cigarette packs to have anti-littering messages, although some packs include such messages generally in very small type on the side of the pack opposite the Surgeon General’s warning. Anti-littering campaigns have targeted the issue of cigarette butt litter in the past and have received support and partial funding from the tobacco industry (Schultz, 2009; Smith and McDaniel, 2011; Beautiful et al., 2021). Instead of sporadic campaigns sponsored by tobacco companies seeking to improve their corporate images and shift the responsibility for tobacco waste from the company to the consumer, the problem of tobacco butt littering could be taken up by policymakers. Regulators could require tobacco companies to place anti-littering messages on cigarette packs, like the mandated health warnings on cigarettes in 126 countries (Campaign for Tobacco-Free Kids, 2017).

Our anti-littering messages avoided language about toxic chemicals in cigarette butts in order not to interfere with the purpose of the main trial (i.e., testing the impact of messages about chemicals in cigarette smoke). Since they were originally designed as control messages, they are weaker than messages that might be designed with anti-littering behavior as the primary goal. We also did not assess social norms about littering, or changes in policy support, as littering was not the primary focus of the trial. Future studies could test anti-littering messages about toxic chemicals that may be more effective in reducing littering and potentially have a spillover effect of discouraging smoking. Future studies should also examine message features that increase policy support for littering regulations. With the increase in disposable e-cigarettes and vaping pods (i.e. Puff Bar and Juul), developing effective messaging strategies to reduce tobacco litter and increase policy support can have a big impact by reducing the harms caused by tobacco litter. Over the longer term, requiring anti-littering messages on packs could release funds originally allocated for tobacco litter clean-up initiatives, which could then be allocated to other pressing public and environmental health issues.

The finding that anti-littering messages led to greater intentions to refrain from littering cigarette butts is promising, but the goal is a reduction in littering behavior. The next step will be to determine which components of anti-littering messages most effectively translate lower littering intentions into a reduction in littering behavior and ensuring that the final messages are effective across a diverse population. While anti-littering pack messages may be an effective way to reduce individual littering behavior, there are other policies needed to change the built environments to support this behavior. Urban environments should have more well-placed and appropriately designed trash receptacles (Schultz, 2009; Schultz et al., 2013); while interventions and messages should aim to change attitudes by targeting social norms that are ambivalent or favorable towards littering (Cialdini et al., 1990). These environmental changes may make it easier for smokers who do not intend to litter to dispose of their cigarette butts properly. The increase in knowledge of cigarette butts as litter may make these types of changes and policies more politically viable.

4.1. Strengths and limitations

Strengths of our trial include the use of random assignment to a condition in a large sample of diverse smokers. Other strengths include repeated exposure to the messages over time and visually matched comparison messages that minimized differences between the antilittering and chemical messages. The main limitation of our trial is that it was not designed to detect the effect of messages on refraining from littering behavior. Furthermore, the littering measures (dropping cigarettes on the ground or out of the car window) did not capture a reduction in a participant’s littering behavior, only the complete abstinence from littering each week. Because a reduction of littering could still have an important environmental impact, it is encouraging that littering pack messages decreased the number of weeks cigarette butts were littered from cars. While there is no reason to suspect that car riding behavior differed between message groups, we did not assess it and therefore cannot rule it out. Littering behavior for the prior week was measured with self-report items; future research may wish to use daily diaries, ecological momentary assessment methods, or observational methods to assess littering behavior. Additionally, our trial did not include a no-message control condition, which would allow for comparisons to the packs that smokers currently use in the U.S. This trial recruited a convenience sample of smokers in California, U.S., and thus the generalizability of our findings within the state and to other locations, particularly low and middle-income countries that face litter and waste management issues, remains to be established. Finally, because of when we collected knowledge, conversation, and perceived effectiveness measures, our mediation analysis was only able to be conducted with the mediators and outcome variables collected at the same time, which limits our ability to infer causality and directionality.

5. Implications for tobacco regulation

Anti-littering messages on cigarette packs led to more knowledge about littering and hold promise for motivating smokers to not litter cigarette butts. More knowledge and higher behavioral intentions to refrain from littering suggests that anti-littering messages may effectively inform smokers and motivate behaviors that may reduce cigarette butt litter.

5.1. Human subjects approval statement

Participants read a consent form that provided the details of their involvement, emphasized that their participation was voluntary, and supplied the contact information for the study Pis and the Institutional Review Board. The University of North Carolina at Chapel Hill institutional review board approved the consent process, trial procedures, and trial materials.

Acknowledgements

The research reported in this publication was supported by grant number P50CA180907 from the National Cancer Institute and FDA Center for Tobacco Products (CTP). Grant number U54CA229973 supported JCM’s time writing and revising the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Footnotes

CRediT authorship contribution statement

Jennifer C. Morgan: Conceptualization, Methodology, Formal analysis, Writing–original draft, Writing– review & editing. Michelle Jeong: Data curation, Writing– review & editing. Jennifer Mendel-Sheldon: Writing– review & editing, Project administration. Seth M. Noar: Conceptualization, Methodology, Writing– review & editing, Funding acquisition. Kurt M. Ribisl: Conceptualization, Methodology, Writing– review & editing, Funding acquisition. Noel T. Brewer: Conceptualization, Methodology, Writing– review & editing, Funding acquisition, Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

  1. Al-mosa Y, Parkinson J, & Rundle-Thiele S (2017). A socioecological examination of observing littering behavior. J. Nonprofit Publ. Sect. Mark, 29(3), 235–253. 10.1080/10495142.2017.1326354 [DOI] [Google Scholar]
  2. Barnes RL (2011). Regulating the disposal of cigarette butts as toxic hazardous waste. Tob. Control, 20(Supplement 1), i45–i48. 10.1136/tc.2010.041301 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Keep America Beautiful. Cigarette Litter Prevention Program. Keep America Beautiful. Published 2021. <https://kab.org/programs/cigarette-litter/> (accessed March 3, 2021). [Google Scholar]
  4. Brewer NT, Hall MG, Lee JGL, Peebles K, Noar SM, & Ribisl KM (2016). Testing warning messages on smokers’ cigarette packages: a standardized protocol. Tob Control, 251136(2), 153–159. 10.1136/tobaccocontrol-2014-051661 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brewer NT, Parada H, Hall MG, Boynton MH, Noar SM, & Ribisl KM (2018). Understanding why pictorial cigarette pack warnings increase quit attempts. Ann. Behav. Med, 10.1093/abm/kay032 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brewer NT, Jeong M, Mendel JR, et al. (2019). Cigarette pack messages about toxic chemicals: a randomised clinical trial. Tob Control, 28(1). 10.1136/tobaccocontrol-2017-054112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Campaign for Tobacco-Free Kids. Global Issues: Warning Labels. Published 07T16:11:00-04:00 2017. <https://www.tobaccofreekids.org/what-we-do/global/warning-labels> (accessed March 1, 2021).
  8. Castaldi G, Cecere G, & Zoli M (2020). “Smoke on the beach”: on the use of economic vs behavioral policies to reduce environmental pollution by cigarette littering. Econ. Polit. 10.1007/s40888-020-00205-5 [DOI] [Google Scholar]
  9. Centers for Disease Control and Prevention. (2009). Health warnings on tobacco products - worldwide, 2007. MMWR Morb. Mortal. Wkly. Rep, 58(19), 528–529. [PubMed] [Google Scholar]
  10. Cialdini RB, Reno RR, & Kallgren CA (1990). A focus theory of normative conduct: recycling the concept of norms to reduce littering in public places. J. Pers. Soc. Psychol, 58(6), 1015–1026. [Google Scholar]
  11. Dillard JP, Weber KM, & Vail RG (2007). The relationship between the perceived and actual effectiveness of persuasive messages: a meta-analysis with implications for formative campaign research. J. Commun, 57(4), 613–631. 10.1111/j.1460-2466.2007.00360.x [DOI] [Google Scholar]
  12. Druckman JN, & Leeper TJ (2012). Learning more from political communication experiments: pretreatment and its effects. Am. J. Polit. Sci, 56(4), 875–896. 10.1111/j.1540-5907.2012.00582.x [DOI] [Google Scholar]
  13. Huffman KT, Grossnickle WF, Cope JG, & Huffman KP (1995). Litter reduction: a review and integration of the literature. Environ. Behav, 27(2), 153–183. 10.1177/0013916595272003 [DOI] [Google Scholar]
  14. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, & Graffunder CM (2016). Current cigarette smoking among adults—United States, 2005–2015. MMWR Morb. Mortal. Wkly Rep, 65(44), 1205–1211. [DOI] [PubMed] [Google Scholar]
  15. Madden TJ, Ellen PS, & Ajzen I (1992). A comparison of the theory of planned behavior and the theory of reasoned action. Pers. Soc. Psychol. Bull, 18(1), 3–9. 10.1177/0146167292181001 [DOI] [Google Scholar]
  16. Morgan JC, Golden SD, Noar SM, Ribisl KM, Southwell BG, Jeong M, et al. (2018). Conversations about pictorial cigarette pack warnings: theoretical mechanisms of influence. Soc. Sci. Med, 218, 45–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Muthén LK, Muthén BO. Mplus. Published online 2017. [Google Scholar]
  18. Niederdeppe J, Heley K, & Barry CL (2015). Inoculation and narrative strategies in competitive framing of three health policy issues. J Commun., 65(5), 838–862. 10.1111/jcom.12162 [DOI] [Google Scholar]
  19. Novotny TE, Hardin SN, Hovda LR, Novotny DJ, McLean MK, & Khan S (2011). Tobacco and cigarette butt consumption in humans and animals. Tob Control., 20(Supplement 1), i17–i20. 10.1136/tc.2011.043489 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Novotny TE, & Slaughter E (2014). Tobacco product waste: an environmental approach to reduce tobacco consumption. Curr. Environ. Health Rep, 1(3), 208–216. 10.1007/s40572-014-0016-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Petty R, & Cacioppo J (1986). The elaboration likelihood model of persuasion. Adv. Exp. Soc. Psychol, 19, 123–205. [Google Scholar]
  22. Proctor Robert N. (2012). Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition (accessed February 26, 2021) (first ed.). University of California Press. [Google Scholar]
  23. Rainey J, August 27, 2018. Plastic straw ban? Cigarette butts are the single greatest source of ocean trash. NBC News. [Google Scholar]
  24. Rainey J, May 26, 2018. Plastic straws clog the ocean and hurt fish. Now there’s a growing movement to ban them. NBC News. [Google Scholar]
  25. Rath JM, Rubenstein RA, Curry LE, Shank SE, & Cartwright JC (2012). Cigarette litter: smokers’ attitudes and behaviors. Int. J. Environ. Res. Publ. Health, 9(9), 2189–2203. 10.3390/ijerph9062189 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Roder Green AL, Putschew A, & Nehls T (2014). Littered cigarette butts as a source of nicotine in urban waters. J. Hydrol, 519, 3466–3474. 10.1016/j.jhydrol.2014.05.046 [DOI] [Google Scholar]
  27. SAS. v. 14.1 Published online 2004.
  28. Schultz PW (2009). Littering Behavior in America. Results of a National Study. Action Research. Keep America Beautiful. [Google Scholar]
  29. Schultz PW, Bator RJ, Large LB, Bruni CM, & Tabanico JJ (2013). Littering in context. Environ. Behav, 45(1), 35–59. 10.1177/0013916511412179 [DOI] [Google Scholar]
  30. Smith EA, & McDaniel PA (2011). Covering their butts: responses to the cigarette litter problem. Tob. Control, 20(2), 100–106. 10.1136/tc.2010.036491 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wakefield MA, Loken B, & Hornik RC (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376(9748), 1261–1271. 10.1016/S0140-6736(10)60809-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Webb TL, & Sheeran P (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol. Bull, 132(2), 249–268. 10.1037/0033-2909.132.2.249 [DOI] [PubMed] [Google Scholar]
  33. Willis GB (2004). Cognitive Interviewing: A Tool for Improving Questionnaire Design. SAGE Publications. [Google Scholar]
  34. Yanovitzky I, & Stryker JO (2001). Mass media, social norms, and health promotion efforts: a longitudinal study of media effects on youth binge drinking. Commun Res., 28(2), 208–239. 10.1177/009365001028002004 [DOI] [Google Scholar]

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