Inequitable exposure to tobacco product litter among adolescents in California, USA.

Introduction: Tobacco waste is a costly, widespread blight and environmental toxicant that is not distributed equally across geographical areas. This investigation reports on the prevalence of noticing tobacco litter and potential inequities in tobacco litter exposure among adolescents in California, USA.

Methods: Data from the 2023 Teens, Nicotine, and Tobacco (TNT) Online Survey (N=4910), a statewide, online cross-sectional survey of California adolescents aged 12-17 years, were analyzed for the self-reported frequency of noticing tobacco product litter. All participants were asked to report how often they notice tobacco product litter (closed-ended response options: almost always, sometimes, once in a while, never). Survey-weighted multivariable regression models were fitted to quantify the odds of noticing tobacco litter 'almost always' according to participant characteristics (age, sex, gender/sexual identity, race/ethnicity, location, family finances, and own and household tobacco use). Data were weighted for geographical and demographic representativeness and response quality.

Results: The prevalence of noticing tobacco litter almost always was 44.6% overall and higher among participants who identified as Hispanic/Latino (50.9%) or LGBTQ+ (53.3%), lived in a small town (57.8%), or whose families were financially disadvantaged (52.7%). These inequities persisted in multivariable models, including adjustment for own and household tobacco use. For example, Hispanic/Latino participants had 1.66-times the adjusted odds of almost always noticing tobacco litter (95% CI: 1.32-2.07; reference: non-Hispanic White); the adjusted odds ratio for LGBTQ+ identity was 1.39 (95% CI: 1.04-1.87; reference: non-LGBTQ+).

Conclusions: The pervasive exposure to tobacco litter observed in this study suggests a need for stronger efforts to reduce tobacco waste, with an emphasis on advancing equity.