Human health impacts from litter on beaches and associated perceptions: A case study of ‘clean’ Tasmanian beaches Marnie L. Campbell a, b, c, * , Chris Slavin a, b , Anna Grage a, b, d , Amber Kinslow a a National Centre for Marine Conservation and Resource Sustainability, University of Tasmania, Locked Bag 1370, Newnham, Tasmania 7250, Australia b School of Medical and Applied Science, Central Queensland University, Bryan Jordan Drive, Gladstone, Queensland 4680, Australia c The Environmental Research Institute, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand d School of Law/Australian National Centre for Ocean Resources & Security, University of Wollongong, Wollongong, New South Wales 2522, Australia article info Article history: Received 27 November 2015 Received in revised form 23 February 2016 Accepted 5 April 2016 Keywords: Environmental management Hazard Marine biota Marine debris Risk abstract People take for granted that injuries occur at beaches. But the evidence for injuries caused by beach litter is lacking within the literature. Therefore, we examined the prevalence of litter related beach injuries at Tasmanian (Australia) beaches. A risk equation was developed to determine injury risk posed by litter based on a user's frequency of beach visitation. Examined beaches are considered ‘clean’ (approximately 1.69 kg of debris per beach) using the Clean Coast Index. Moderate proportions (21.6%) of beach users received injuries from beach litter, illustrating that even clean beaches pose a threat of injury. Realised risk was high; with wounds (65%) being the most common injury. Daily beach visitation decreased injury risks (high to moderate/high). Respondents seldom (12.9%) recognise beach litter injuries as a major concern, instead focussing on impacts that litter in the marine environment (including beaches) has on marine biota. Respondent's perceptions of cause and responsibility of beach litter are discussed, with implications provided within a re-education context. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction Beaches are iconic places often associated with positive mem- ories that result in repeated visits (e.g., Wells, 1982; Kozak, 2001; Alegre and Garau, 2010). Unfortunately, despite their positive per- ceptions, beaches are also associated with hazards such as drowning (e.g., Aldraldes and Perez-Gomez, 2009; Avramidis et al., 2009), sports injuries (e.g., Bahr and Reeser, 2003; Chang et al., 2006; Eldridge, 2008), marine stings (e.g., Haddad et al., 2002; Pommier et al., 2005; Gershwin et al., 2009), aquatic accidents (e.g., Woolgar et al., 2001; Klein et al., 2003; Adraldes and Perez- Gomez, 2009) and marine debris that result in beach litter (e.g., Ivar de Sul and Costa, 2007; Oigman-Pszczol and Creed, 2007; Slavin et al., 2012). These hazards are often recognised in legislation but taken for granted by beach users. Studies have indicated that tourist death and injury is commonly associated with drowning, interactions with wildlife (stings, bites), and water sports (e.g., Taylor et al., 2002, 2004; Staines et al., 2005; Morgan et al., 2009); which has led to beach safety initiatives typically focussing on water safety (Heggie, 2013) as opposed to beach safety. Few studies have examined the role of beach related safety, but Heggie (2013) has suggested that a broadening of focus to encompass beach safety is required. With this in mind, this study explores some of the health issues associ- ated with beach litter that is deposited upon beaches. Ivar do Sul and Costa (2007) have suggested that the damage to human health as a result of beach litter has been underestimated for many decades, and that it is partly supported by a dearth of published literature on the human dimensions of this hazard. There are a large number of publications that focus on the significant threat that litter in the marine environment poses to wildlife (e.g., Laist, 1987; Moore, 2008; Chiappone et al., 2005; Boerger et al., 2010; Müller et al., 2012; Verlis et al., 2013). Examples of impacts to wildlife include ingestion, entanglement, and choking with subsequent mortality by turtles and marine mammals (e.g., Laist, 1997; Bugoni et al., 2001; Thompson et al., 2009); and use of plastics within seabirds nests that can lead to ingestion (Verlis et al., 2013, Verlis et al., 2014). Few papers have focussed on realised threats posed to humans (e.g., Grenfell and Ross, 1992; Phillip et al., 1997; Ivar do Sul and Costa, 2007; Sheavely, and Register, 2007). Yet * Corresponding author. The Environmental Research Institute, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand. E-mail address: mcampbel@waikato.ac.nz (M.L. Campbell). Contents lists available at ScienceDirect Ocean & Coastal Management journal homepage: www.elsevier.com/locate/ocecoaman http://dx.doi.org/10.1016/j.ocecoaman.2016.04.002 0964-5691/© 2016 Elsevier Ltd. All rights reserved. Ocean & Coastal Management 126 (2016) 22e30