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However, given the robustness of the reported substitution effect, these additional factors are unlikely to change the main finding of a significant general substitution effect between ENDS and cigarettes

So better education in schools and for parents and teachers is also needed, so they know how to talk to kids about vaping and what to do if they know someone is vaping

You send another group, they may focus on the larger items and miss all of that. Yet the prevalence of cigarette butts is consistent with the aggregated global International Coastal Cleanup tally, which has consistently seen cigarette butts topping its list of top-10 most-found items every year