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In one focus group cited in industry documents, smokers said tossing their butts to the ground was a natural extension of the defiant/rebellious smoking ritual. Their efforts anti-litter campaigns and handheld and permanent ashtrays did not substantially affect smokers' entrenched butt flicking behaviors, said a research paper co-authored by Novotny

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With the rise of alternate forms of tobacco (e-cigarettes, hookah, etc.) tobacco continues to be a large public health concern