Cleaner and Responsible Consumption 12 (2024) 100175

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Cleaner and Responsible Consumption

journal homepage: www.journals.elsevier.com/cleaner-and-responsible-consumption

The effects of perceptions of environmental health risk and environmental

risk on sustainable infectious waste management behaviours among
citizens in Bangkok, Thailand
Piyapong Janmaimool a, *, Jaruwan Chontanawat b, c, Surapong Chudech b
a
ASEAN Institute for Health Development, Mahidol University, 999 Salaya, Nakhon Pathom Province, 73170, Thailand
b
Department of Social Sciences and Humanities, School of Liberal Arts, King Mongkut’s University of Technology Thonburi, 126 Pracha-Uthit Rd., Thungkru, Bangkok,
10140, Thailand
c
The Joint Graduate School of Energy and Environment (JGSEE), King Mongkut’s University of Technology Thonburi, 126 Pracha-Uthit Rd., Thungkru, Bangkok,
10140, Thailand

A R T I C L E I N F O A B S T R A C T

Keywords: This study aims to examine how people’s perceived characteristics of environmental risks and environmental
Sustainable infectious waste management health risks, as associated with COVID-19 infectious waste problems, affect their participation in sustainable
behaviors infectious waste management behaviours (i.e. infectious waste minimization, waste collection awareness, and
Environmental health risk perception
infectious waste segregation). Questionnaires were conducted with 521 people living in Bangkok, Thailand.
Environmental risk perception
Confirmatory factor analysis (CFA) was carried out to validate the study variables, followed by structural
Pro-environmental behaviour
Sustainable development equation modelling (SEM) to test how perceived characteristics of environmental risks (perceived ecological
threat occurrence to the environment and perceived severity of the threat to the environment), the environ­
mental health risks themselves (perceived ecological threat occurrence to human health and perceived severity of
the threat to human health) and socio-economic characteristics influence individuals’ sustainable infectious
waste management behaviours. The results revealed that perceived ecological threat occurrence to the envi­
ronment and human health did not statistically affect all types of sustainable infectious waste management
behaviours, but perceived severity of the ecological threat to human health significantly affected individuals’
infectious waste minimization and segregation. Perceived severity of the ecological threat to the environment
only affected infectious waste collection awareness. In addition, the respondents’ age and education level
positively and significantly affected most types of behaviours, whereas income only had a negative effect on
respondents’ infectious waste minimization. These results provide implications for the development of
communication strategies to motivate people to participate in sustainable infectious waste management
behaviours.

1. Introduction
Since the coronavirus outbreak became a global pandemic in March
2020, several countries have recommended that their citizens wear face
masks in public to reduce the transmission of the virus (Cai et al., 2020;
Pandit et al., 2021), and to use antigen-detecting rapid diagnostic tests
(Ag-RDT) to detect and control infection (World Health Organization,
2021). New normal living in response to the COVID-19 outbreak has
caused a massive increase in infectious waste upon the practising of
health protection measures, such as using personal protective equip­
ment (PPE; e.g. hand gloves, face masks, face shields, etc.) and
self-administered rapid test kits in daily life. Most PPE and rapid test kits
become infectious waste after being used (Jung et al., 2021). In addition,
they are mostly made from plastics, which directly impact the envi­
ronment once they are disposed of and later degrade (Rume and Islam,
2022). This makes the drastic increases in the quantities of infectious
waste most concerning, requiring their effective management (Jung
et al., 2021). According to the WHO (2022) and Das, (2021), a massive
increase in infectious waste from the COVID-19 pandemic has exacer­
bated environmental problems and posed a serious threat to human
health and environmental quality. Many scholars, including Roberts
et al. (2020), Bouchet et al. (2021) and Hartanto and Mayasari (2021),

* Corresponding author.
E-mail addresses: piyapong.jan@mahidol.ac.th (P. Janmaimool), Jaruwan.cho@kmutt.ac.th (J. Chontanawat).

https://doi.org/10.1016/j.clrc.2024.100175
Received 27 July 2023; Received in revised form 20 January 2024; Accepted 25 January 2024
Available online 5 February 2024
2666-7843/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
P. Janmaimool et al.
have confirmed that the increase in the quantity of infectious waste is
due to the growth in the production, patronage and use of face masks
specifically. The WHO (2022) further reported that since the emergence
of COVID-19 until December 2021, over 140 million COVID-19 test kits
had been procured by the United Nations (UN), and those test kits had
the potential to generate approximately 2600 tons of general waste.
Improper disposal of this infectious waste can cause environmental
contamination as well, for once in the environment, face masks and
other plastic waste begin to degrade upon weathering. During these
processes, the plastics in the waste transform into microfibers that can
enter both land and aquatic ecosystems (Mohamed et al., 2022; Saliu
et al., 2021). These microfibers are composed of micro and nano plastics
(183–1247 particles per piece) as well as organic pollutants that can
then enter the ecological food chain and contaminate environmental
systems and human food (Bouwmeester et al., 2015; Chang et al., 2020).
Rathinamoorthy and Raja Balasaraswathi (2022) and Shen et al. (2021)
found that when exposed to natural weathering, disposable face masks
could increase the release of microfibers from 71.06% to 99.99%. The
WHO (2018) added that pathogens and toxic pollutants released to the
environment during the process of infectious waste disposal and treat­
ment can pose a serious health risk to humans, as microplastics can enter
and accumulate in human lungs, placenta, hair, skin and blood (Abbasi
et al., 2019; Goodman et al., 2021; Leslie et al., 2022), which affects cell
morphology and inhibits cell proliferation (Goodman et al., 2021). Yee
et al. (2021) also indicated that people who are exposed to microplastics
may develop inflammation, apoptosis and metabolic homeostasis.
Ecological and environmental impacts caused by the improper
management of infectious waste are also concerning. Several aquatic
animals have been affected by the presence of used face masks in surface
water resources, as animals often mistakenly consume plastic materials
from face masks as food, and thus suffer with malnutrition (Keiron et al.,
2020). Fauna can also be affected by littered face masks; one report from
Columbia explained that a bird died because its body and beak were
wrapped up in a discarded face mask (Boyle, 2020). In addition, the
improper management of infectious waste generated from used PPE can
increase the chance of viral infection, with Haque et al. (2021a,b)
finding that the COVID-19 virus can adhere to the surface of tested
materials and infectious waste for a long time. Consequently, the virus
can be transmitted to humans upon contact with the infected waste.
Despite its necessity, the management of infectious waste is complex
and challenging. Though untreated infectious waste is disposed of in
landfills, environmental contaminations, such as that of surface and
underground water, can still occur if the landfills are not properly built.
Incineration of infectious waste is widely practised to avoid this issue;
however, this releases other pollutants into the air and generates ash
residue. The dioxins and furans generated from incinerated materials
containing chlorine in particular can cause serious health impacts
(WHO, 2018). In this way, it is important to find a sustainable way to
manage infectious waste. Several countries also now face infectious
waste management problems due to the great volume of waste which
exceeds the capacity of their waste management systems (Knowlton,
2019). According to the U.S. EPA (2020), developing countries produce
COVID-19 infectious waste at a rate of approximately 2.5 kg per bed per
day. In Thailand, the disposal of infectious waste became a critical
problem in August 2021: Approximately 432.5 tons of infectious waste is
produced per day, but local incinerators have the capacity to dissolve
only 305 tons per day (WHO, 2022). In response to this issue, the Bureau
of Environmental Health, Thailand employed industrial waste process­
ing factories and upscaled local incinerators to dispose of the excess
waste.
The major sources of infectious waste from COVID-19 are from
healthcare establishments such as health centres, hospitals, quarantine
facilities, clinics, autopsy centres and laboratories. Infectious wastes
generated by these healthcare establishments are highly infectious
waste including used sharps, liquid waste from diagnostic machines,
reagents, spent cartridges and blood collection tubes. However, most of
2
Cleaner and Responsible Consumption 12 (2024) 100175
those healthcare facilities have implemented infectious waste manage­
ment systems which can help mitigate environmental and health im­
pacts. Another major source of infectious waste is from households. With
limited access to medical support, increased numbers of infected cases
have to self-medicate at home. Additionally, the use of PPE by general
people also contributes to a massive increase in the quantity of infectious
waste. This situation is very concerning as it has been reported that a
great amount of household infectious waste was not properly managed.
This study, therefore, focuses on the management of infectious wastes
generated from households. Several studies have revealed that the way
people use and dispose of PPE and rapid test kits could destroy the
environment and impact human health (Liu, 2020; Shutterstock, 2021;
Singh et al., 2022). Nevertheless, inappropriate littering of used face
masks has steadily increased in many countries (Shutterstock, 2021).
For instance, during a beach cleaning of Britain’s most popular tourist
beaches in September 2020, more than 100 face masks were recovered
(Liu, 2020). In addition, many people are not aware of waste separation;
thus, they mix recyclables with other waste. This increases the volume of
general waste that goes to landfills and hinders the proper management
of infectious waste, such as high-temperature incineration. Mixing
several types of waste also prevents the recovery of recyclables. Singh
et al. (2022) indicated that the low cost of face masks and people’s lack
of awareness of the negative impact of infectious waste on the envi­
ronment and human health yield a great level of consumption and the
waste’s improper disposal. Therefore, the way people use PPE and
dispose of it should become more sustainable and safer (Jung et al.,
2021). The WHO (2017) suggested an effective health care waste
management method which includes five steps: waste classification and
segregation; waste minimization; waste handling and collection; waste
on-site transport; and waste treatment and disposal. To complete this
effective health care management, people who produce infectious waste
should particularly take part in waste minimization, segregation and
collection.
Encouraging people to participate in sustainable infectious waste
management behaviours is also very challenging, as people’s decision to
perform a behaviour is based on varying factors. Risk communication
has been proved to be effective in enhancing people’s awareness and
motivation to participate in sustainable behaviours (Zeng et al., 2020)
and preventive behaviours (You et al., 2023). Risk communication en­
ables people to construct a risk perception which finally motivates them
to perform environmental related behaviours (Maartensson and Loi,
2022) or preventive behaviours (Cooper et al., 2020). Namely, when
people feel that they or their valued things might be negatively impacted
by a potential threat, they are likely to response to the risk by per­
forming adaptive and response actions (Boss et al., 2015). As indicated
in Protection Motivation Theory (PMT; Rogers, 1975), individuals’
estimation of the level of threat to themselves and their valued things (e.
g. personal health, the health of others or the environment) can
contribute to their decision to perform actions that mitigate risk. An
effective risk communication is therefore important to enhance people’
risk perception and motivation to perform a concerned behaviour.
To develop effective risk communication strategies, it is important to
understand types of risk messages which can have a significant impact
on people’ concerned behavers (Lin and Petersen, 2008). Understanding
significant associations between individuals’ perception of risk charac­
teristics and concerned behaviours can help identifying potential risk
messages (Fitzpatrick-Lewis et al., 2010). However, the concept of risk
itself has diverse dimensions such as possibility of threat occurrence and
severity of its consequence (Sjöberg et al., 2004). In addition, risks can
be divided into several types based on objects or things that a hazard or
harmful event can affect. For instance, environmental risk perception
concerns disruptions or impactful events on the environment or
ecological elements, such as plants, animals and even non-biotic ele­
ments (Slimak and Dietz, 2006). In turn, environmental health risk
perception concerns the impact of environmental conditions on people’s
health and well-being (Asuzu, 1994). Therefore, risk messages can be
P. Janmaimool et al.
diverse. Considering risks associated with COVID-19 infectious waste
which can have negative impacts on both human health and the envi­
ronment, individuals’ risk perception can be therefore divided into two
types including environmental risk and environmental health risk per­
ceptions. Accordingly, potential risk messages related to COVID-19 in­
fectious waste can be very diverse. To develop effective risk
communication strategies for promoting sustainable infectious waste
management behaviours, it is therefore important to understand a type
of risk perception and risk messages which can have a significant effect
on the behaviours.
Regarding available current studies, though many studies have
revealed that risk perception can motivate people to perform environ­
mental behaviours, none of these explore how several types of risk
perception (e.g. environmental risk perception and environmental
health risk perception) can significantly affect environment-related be­
haviours, particularly sustainable COVID-19 infectious waste manage­
ment behaviours. Knowing the types of risk perception that affect
people’s decisions to perform sustainable behaviours can inform the
development of related communication strategies. The main goals of this
study are to gain insight understanding on how to develop risk
communication strategies for promoting sustainable infectious waste
management behaviours and to identify target groups which risk
communication should be implemented with. Based on these goals, the
association between individuals’ sustainable infectious waste manage­
ment behaviours and variables related to environmental risk and envi­
ronmental health risk perceptions, and the association between the
behaviours and socio-economic characteristics will be explored.
For the objectives of this study, this study first aims to explore
participation in sustainable infectious waste management behaviours
among people living in Bangkok, Thailand, which has been facing a
great amount of infectious waste as a highly populated area. It also ex­
plores how these people perceive environmental risk and environmental
health risk characteristics in relation to COVID-19 infectious waste­
–related problems. In addition, this study aims to examine how those
perceived characteristics as well as the citizens’ socio-economic char­
acteristics (i.e. income, age and education) affect their participation in
sustainable infectious waste management behaviours, including infec­
tious waste minimization, collection awareness and segregation. The
results could provide implications for the development of communica­
tion strategies that promote public engagement in sustainable infectious
waste management behaviours.
2. Literature reviews, conceptual framework and hypotheses
2.1. Sustainable COVID-19 infectious waste management behaviours
According to the WHO (2017), infectious waste refers to waste that is
suspected to contain pathogens in adequate concentrations to cause
disease transmission. Infectious waste is generally contaminated with
blood or other body fluids, while highly infectious waste is contami­
nated with laboratory cultures and microbiological stocks, including
used sharps, liquid waste from diagnostic machines, reagents, spent
cartridges and blood collection tubes. Materials that have been in con­
tact with infected patients are also considered infectious waste. Upon
the outbreak of COVID-19, general citizens became infectious waste
producers, as they have been encouraged to wear face masks for pro­
tection against the virus, and to use Ag-RDT to detect infection. Inevi­
tably, the increased use of disposable PPE and diagnosis kits has led to a
just as massive increase in potentially infectious waste which may pose
health and environmental threats.
Our world is now facing a challenging environmental problem that
demands people’s participation in pro-environmental practices (Steg
and Vlek, 2009). Massive increases in the amount of infectious waste
generated by individuals and improper management of this waste have
exacerbated this environmental problem. Therefore, in this new normal
living, several organizations and scholars have suggested people’s
3
Cleaner and Responsible Consumption 12 (2024) 100175
participation in sustainable infectious waste management to avoid
environmental and health impacts. The WHO (2017) suggested ways to
manage infectious waste, with some stages of these methods requiring
people’s active participation such as waste classification and segrega­
tion. Omar et al. (2012) indicated that waste segregation helps effi­
ciently manage infectious waste by reducing the amount of waste that
must be treated as hazardous. In addition, waste segregation can help
reduce the cost of waste treatment (WHO, 2017). Regarding COVID-19
waste management, the WHO (2021) recommended that waste gener­
ated from PPE use should be disposed of in a strong and noticeable bag
that is closed before it is collected by the responsible organizations.
In turn, general non-infectious health care waste should be properly
separated from infectious waste, such as pathological or sharp waste.
Mosquera et al. (2014) and Windfeld and Brooks (2015) proposed that
the separation of recyclable waste from potentially infectious waste
must be taken into consideration as well. If recyclable waste is efficiently
segregated, it will minimize the volume of waste that is sent for treat­
ment and disposal, and help maintain resource efficiency as well as
material recovery. Another waste management strategy is waste mini­
mization, which is the most preferable approach, because it involves
producing as little waste as possible (WHO, 2017). Waste minimization
aims to prevent or reduce the generation of waste by emphasizing source
reduction and recycling. In the context of COVID-19 prevention, ac­
cording to the UK’s Department for Environment, Food & Rural Affairs
(2021) and the WHO (2021), people should use cloth face masks instead
of single-use face masks to prevent and reduce the amount of infectious
waste generated. In addition, people are encouraged to use sustainable
reusable masks that are made from recycled materials, such as recycled
plastic or water bottles (Block, 2020; Gupta et al., 2021; Haque et al.,
2021a,b; Leal Filho et al., 2021). The WHO (2021) also promoted the use
of safe and reusable PPE.
Waste collection is important to effective infectious waste manage­
ment as well. According to the WHO (2017), infectious waste must be
safely collected before being sent for treatment and disposal. However, it
is also important to ensure that facilities such as infectious waste con­
tainers or bags are sufficiently provided for people to properly dispose of
infectious waste. At the same time, people should be aware of its proper
collection and disposal by not littering or leaving used PPE in the
environment. Several reports have revealed that a great number of used
face masks were found in natural areas such as beaches and oceans (Liu,
2020; Shutterstock, 2021). Based on this discussion, to achieve sus­
tainable infectious waste management, there are several actions that
people should perform. This study therefore explores people’s partici­
pation in these sustainable infectious waste management behaviours,
notably waste minimization, segregation and collection.
2.2. Environmental risk and environmental health risk perceptions
To encourage people’s participation in sustainable infectious waste
management behaviours, this study focuses on the influence of in­
dividuals’ perceived risks associated with COVID-19 infectious waste­
–related problems. As stated by many scholars, a massive increase in
infectious waste can be a major threat to the environment and human
health (Bouchet et al., 2021; Hartanto and Mayasari, 2021; Roberts
et al., 2020). Thus, it can be assumed that once individuals construct
risks associated with this large amount of COVID-19 infectious waste,
they might be aware of its negative impacts and decide to perform
sustainable infectious practices.
Theoretically, risk perception can be defined as an individual’s
subjective assessment of the probability of a specified type of threat
occurrence and potential adverse consequences (Sjöberg et al., 2004).
Similarly, Renn (2017) defined risk perception as individuals’ expecta­
tion of how a harmful event can occur and how much harm it can cause.
Rogers’s (1975) PMT defines risk perception as individuals’ estimation
of the level of threat to themselves and their valued things (e.g. personal
health, the health of others or the environment). Individuals’ perceived
P. Janmaimool et al. Cleaner and Responsible Consumption 12 (2024) 100175

risks can motivate them to take adaptive actions (Boss et al., 2015), as importance to environmental values may decide to perform actions to
per the psychometric paradigm (Slovic, 2000), individuals’ risk mitigate environmental problems. The threat associated with a massive
perception is based on their rational thinking process and their inter­ increase in COVID-19 infectious waste can generate such negative
pretation and understanding of risk characteristics. Slovic (2000) environmental change, and thus affect human health.
emphasized individuals’ interpretation of hazard characteristics (i.e.
threat occurrence and threat severity) that enable people to construct
2.3. Conceptual framework and hypotheses
risks. Once individuals recognize the possibility of threat occurrence,
they start assessing the risk that they may face. Accordingly, individuals
This study aims to explore how individuals’ perceived environmental
assess the threat’s catastrophic consequence(s) and judge the extent of
risk and environmental health risk characteristics (including threat
the potential impacts that they or their value things would undergo.
occurrence and severity) affect their participation in sustainable infec­
Individuals who are aware of potential threat occurrence and cata­
tious waste management behaviours (see Fig. 1). As stated by Slovic
strophic consequences tend to also construct their ability to face risks.
(2000), the ways people construct risks could shape how they act or
Several scholars have confirmed that, to perceive risk, an individual,
respond to those risks. Duan and Fortner (2010) proposed that the public
group of people or society needs to evaluate the probability of hazard
perception of various environmental risks leads to public concerns, and
occurrence, as well as the adverse consequences of a negative outcome
then to the decision to perform actions responding to those risks. Based
(Slovic, 1987; Wachinger et al., 2013). Slovic (1987) added that the
on the Health Belief Model (HBM; Rosenstock, 1974), once individual
adverse consequences caused by a hazard may happen to the environ­
construct risks, those individuals value the benefits from behavioural
ment or human health, and individuals’ judgement of adverse conse­
changes and consider barriers that they may face when practising health
quences can be influenced by hazard features and/or personal beliefs.
behaviours. Finally, they decide whether they should practise those
Risk perception can be further classified into several types based on
concerning behaviours. Regarding the perception of environmental
objects or things that can be potentially affected by a hazard or harmful
risks, Lin et al. (2021) and Lieske et al. (2014) found that when in­
event. In this study, which focuses on the threat from a massive increase
dividuals who are concerned about the environment have perceived
in COVID-19 infectious waste, the threat can have negative impacts on
environmental risks, their sense of urgency and responsibility can be
both environmental systems and human health. Thus, risk perception in
constructed or enhanced. Accordingly, they consider practising behav­
this study is classified into two types: environmental risk perception and
iours that benefit the environment. For instance, Pahl et al. (2005) and
environmental health risk perception. Regarding the first, Slimak and
Schmitt et al. (2019) revealed that people’s pro-environmental behav­
Dietz (2006) defined environmental risk perception as the perceived
iours are influenced by their risk perception. Jeong et al. (2021)
impacts of disruption or an event on the environment or ecological el­
demonstrated that pro-environmental intention is significantly associ­
ements, such as plants, animals and humans. Any disruptions or harmful
ated with the perception of marine microplastic pollution. Similarly, for
events that create adverse impacts on the environment can be called
the perception of environmental health risks, which focuses on health
ecological threats, which Beck (1992) claimed mostly arise from the
impacts caused by an ecological threat, PMT indicates that people adopt
modernization process. Related, Yu and Xie (2006) and Zhang (2013)
defensive or protective actions to reduce the likelihood of facing a risk
defined environmental risk perception in reference to an individual’s
when confronted with a harmful event (Rogers, 1975). Terpstra et al.
perceived severity of an ecological threat, possibility of ecological threat
(2009) and Bubeck et al. (2012) likewise found that people’s perceived
occurrence and persistence of the risk.
flood risks to their health and well-being contributed to their practice of
Besides posing a risk to the environment, threats can also pose a risk
flood mitigation measures. Additionally, Linden (2015) and Lacroix and
to human health through negative changes in environmental elements.
Gifford (2018) reported that climate change risk perception stimulated
This type of risk can be called environmental health risk. As stated by the
people to practise energy-saving behaviours.
WHO (2016) and the Australian Government Department of Health
With regard to the massive increase in COVID-19 infectious waste
(2014), environmental health refers to conditions in the environment
due to people’s extensive use of PPE and self-administered rapid test kits
such as air, water and soil that can influence human health and
in daily life, a risk to both the environment and human health can arise,
well-being. Environmental health risk is therefore defined as the risk
as discussed in the introduction. Therefore, it can be assumed that
associated with environmental factors (air, water, soil, food, light, noise
people’s perceptions of the characteristics of environmental and envi­
and hygiene) (Asuzu, 1994). Environmental health risks cause negative
ronmental health risks positively affect their sustainable infectious
impacts for people and often lead to their preventive responses (Estévez
waste management behaviours, including infectious waste minimization
et al., 2015; Smith and Mayer, 2018). Namely, when people are aware of
and infectious waste segregation (see Fig. 2). Additionally, this study
environmental health risks and pay attention to them, they are likely to
treated individuals’ awareness of proper infectious collection as a type
realize the importance of environmental problem mitigation measures
of sustainable infectious waste management behaviour, though it has
and the improvement of environmental quality. Consequently, they are
different features from another two types of behaviour explored in this
more willing to act pro-environmentally. Similarly, upon perceiving
study. Individuals’ infectious waste collection awareness can be asso­
environmental risks, people who care about the environment and give
ciated with practices that can ensure a proper collection and

Fig. 1. Perceptions of environmental risk and environmental health risk characteristics and sustainable actions.
Source: Created by authors (2022)

4
P. Janmaimool et al.
Fig. 2. Conceptual Framework
Note: see glossary of acronyms in Table 1.
management of infectious waste. Those practices are such as not
forgetting a used face mask in a public area or carefully keeping in-use
face masks. This current study assumed that if individuals perceived the
potential environmental and health impacts caused by infectious waste,
they would be aware of their masks and put some efforts to ensure that
those used masks will be properly managed. Thus, levels of forgetfulness
and the times that individuals lost their used masks can vary among
individuals with different degree of risk perception.
Furthermore, this study assumes that a population’s socio-economic
characteristics might also affect sustainable infectious waste manage­
ment behaviours. One socio-economic characteristic which has been
widely explored for its relationship with environment-related behav­
iours is age. Knowing which age groups in a population are willing or
hesitant to act sustainably can imply the need for a communication or
education campaign for each age group. Several studies conducted be­
tween 1970 and 1980 have already revealed that younger groups are
more likely to act sustainably (Buttel, 1979; Hines et al., 1986; Liere and
Dunlap, 1980). In contrast, later studies indicated a positive association
between age and pro-environmental behaviour, wherein older groups
are more likely to participate in environmental behaviours than younger
groups (Otto and Kaiser, 2014; Wiernik et al., 2013), as it is possible that
older groups have more experiences with adverse environmental events
(e.g. diversity loss, sea level rise, disaster events or environmental
pollution). As such, they realize the importance of environmental
behaviour practices. However, some scholars have argued that younger
groups are better informed or educated about environment-related is­
sues due to their capability to access digital communications or the
internet. Consequently, younger people have more understanding of
environmental issues such as climate change, and become more likely to
act environmentally (Bedard and Tolmie, 2018; Furlow and Knott,
2014). This current study assumes that age is associated with infectious
5
Cleaner and Responsible Consumption 12 (2024) 100175
waste management behaviours, and younger ages might be more likely
to participate in those behaviours due to their capacity to access
environment-related information. Regardless of outcome, knowing how
each population responds to environmental and health challenging
problems can provide implications for the development of effective
communication policies (Smith and Kingston, 2021).
Education level is another socio-economic factor that has been
widely explored for its association with environment-related behav­
iours, because it can be connected to environmental variables (Berger,
1997; Hines et al., 1986). Several studies have revealed that people with
a higher educational level tend to have a higher level of environmental
concerns as well (Gifford and Nilsson, 2014; Liere and Dunlap, 1980).
Meyer (2015) explained that educational attainment can encourage
people to care more about the welfare of their society, including the
environment, and that education enables people to realize the external
benefits of their behaviours or actions. This study thus assumes that
individuals with a higher education level are more likely to participate
in infectious waste management behaviours due to their ability to un­
derstand environmental situations, and to recognize the importance of
infectious waste management behaviours.
Income level can also be associated with sustainable behaviours in
several ways. First, some environmental behaviours are costly, meaning
low-income people can hardly participate in them. Second, many low-
income people live in areas that are vulnerable to environmental
threats, such as climatic phenomena. Thus, they could have experiences
with adverse environmental consequences and be more aware of envi­
ronmental problems, leading to the decision to act environmentally. For
instance, Hallegatte and Rozenberg (2017) and the International Mon­
etary Fund (2017) revealed that climate change phenomena mostly
negatively influence low-income people with limited resources. In turn,
Hardoy and Pandiella (2009) stated that low-income people might well
P. Janmaimool et al.
understand the effect of climate change, but not the causes or appro­
priate counteractions. Therefore, they might not participate in
pro-environmental behaviours. These conflicting findings show that the
relationship between income level and environmental behaviours is still
ambiguous. This study therefore only generally assumes that income
level affects individuals’ participation in sustainable infectious waste
management behaviours.
3. Methods
3.1. Study area
Bangkok, the capital city of Thailand, was selected as the study area
for this research, because it is highly populated and sees a great amount
of infectious waste generation due to the massive use of PPE among its
residents. According to the Environment Department’s 2022 Annual
Report, Bangkok Metropolitan Administration (BMA) (2022), during the
COVID-19 outbreak in 2021, though the total amount of solid waste
generation in Bangkok decreased, the amount of plastic and infectious
waste increased. The Environmental Department, the BMA also reported
that in 2021, approximately 74.17 tons of infectious waste were daily
generated in the BMA, whereas there were only 43.24 tons per day
generated in 2020. This drastic increase was attributed to the intensive
use of health care materials by both health care sectors and households.
To manage infectious waste, the BMA already provides infectious waste
incineration, though it only has the capacity to dispose of 50 tons per
day of infectious waste – less than the total amount of infectious waste
generated in the BMA per day. Therefore, the BMA requires a more
effective infectious waste management system; otherwise, it could
potentially face critical environmental and health problems.
3.2. Research tools
A questionnaire was used to collect the data in this study. The
questionnaire items are presented in Table 1 according to each study
variable. The participants’ sustainable infectious waste management
behaviours were divided into three categories based on recommenda­
tions from the WHO (2017). The first category is waste minimization,
which refers to people’s efforts to reduce the amount of generated waste
by adopting strategies such as reusing or recycling. Regarding the
minimization of COVID-19 waste, the WHO (2021) suggested using
cotton or recycled masks. Therefore, the participants in this study were
asked to indicate their frequency of participating in this type of behav­
iour based on a 5-point Likert scale ranging from 1 (never) to 5 (regularly)
(Liu and Wu, 2013). The second type of sustainable infectious waste
management behaviour is infectious waste collection awareness. As
suggested by the WHO (2017), infectious waste must be carefully
collected, and should not be released to the environment. To measure
the participants’ participation in infectious waste collection awareness,
a 5-point Likert scale ranging from 1 (never) to 5 (regularly) was used,
with the participants asked to indicate whether they were aware of the
release of their used face masks into the environment. The last type of
sustainable waste management behaviour is infectious waste segrega­
tion, which the WHO (2021) and the UK’s Department for Environment,
Food & Rural Affairs (2021) suggested for PPE, including face masks and
self-administrated rapid test kits, to avoid negative impacts on the
environment and human health. Namely, recyclable waste should be
separated from hazardous waste that is contaminated with blood or
other body fluids. For this study, the participants were asked to indicate
their participation in a number of infectious waste segregation activities
based on different 5-point Likert scales e.g. “1 (never) to 5 (always)").
In measuring the variables related to individuals’ perceived char­
acteristics of environmental risks, including perceived environmental
impact occurrence and perceived harmfulness of environmental im­
pacts, this study adapted questionnaire items from Zhang (2013).
Five-point Likert scale questions ranging from 1 (completely disagree) or
6
Cleaner and Responsible Consumption 12 (2024) 100175
(extremely low) to 5 (completely agree) or (extremely high) were used to
explore the participants’ perceptions of potential environmental impacts
caused by COVID-19 infectious waste. For the measurement of perceived
characteristics of environmental health risks, this study adapted ques­
tions from Flynn et al. (1994) and Zhang (2013). These questions aimed
to explore how individuals perceive the seriousness of the impact of
environmental hazards on human health, as well as the possibility of
human society being influenced by environmental hazards. Five-point
Likert scale questions ranging from 1 (completely disagree) or
(extremely low) to 5 (completely agree) or (extremely high) were also used
for these questions. For socio-economic variables, the participants were
asked to indicate their actual age, monthly income and highest educa­
tional degree.
The questionnaire developed for this study was validated using the
content validity technique, wherein experts in the field of environmental
studies evaluate the questionnaire for its ability to measure the study
variables. After revisions in accordance with the experts’ suggestions,
the questionnaire was tested among 30 people who were not research
participants to test its reliability. The results of this pre-survey revealed
the Cronbach’s alpha coefficient values for each questionnaire variable
to be greater than 0.70 (Cronbach, 1951), and that for the entire ques­
tionnaire to be 0.82.
3.3. Participants and data collection
People who lived in Bangkok, Thailand and practised individual
COVID-19 protection measures were the research participants of this
study. The exclusion criteria were people who worked in health care
sectors, such as medical staff; who were infected with COVID-19 at the
time of the study; or who were responsible for caring for COVID-19-
infected people. According to recommendations from the WHO
(2020a, b), these groups of people are required to put on durable or
advanced face masks (e.g. N95 masks), so they can hardly practise
certain types of sustainable infectious waste management behaviours,
such as using cotton or recycled face masks.
The sample size for this study was determined based on Cochran
et al.’s (1953) calculation formula, because the total population was
unknown. The Cochran formula allows researchers to calculate a sample
size based on a desired level of precision, desired confidence level, and
the estimated proportion of the attribute presented in the population
(Biglari et al., 2019). In calculating the sample size for this research, the
confidence level was set at 95% (error at 5%), and the result revealed an
appropriate sample size of 385 participants. However, to address errors
in some cases and enhance the reliability of the results, this research
distributed 550 questionnaire sheets to the sampling group via a random
sampling technique.
Bangkok metropolitan area contains 50 districts. This study selected
5 districts with the largest population as of 2021 (Bangkok Adminis­
trative Strategy Division, 2022). Those districts are such as Sai mai (206,
831), khlong sam wa (206,437), Bang khae (192,431) Bang Khen (186,
200) and Bang Khun Thian (184,944). A convenience sampling tech­
nique was used to recruit research participants from those 5 districts.
One hundred and ten residents in each target district were invited to
participate in the data collection, and both face-to-face (F2F) and online
questionnaire surveys were employed to collect data. The questionnaires
were conducted from 15 October to November 9, 2022. In total, 521
samples were included in the analysis; the remaining 29 samples were
not completed and therefore excluded. Most participants were female
(320), accounting for 61.4% of the sample, while the number of male
participants was 181 (34.7%). The participants who did not want to
identify their sex amounted to 3.8% (20 persons). Participants between
the ages of 20 and 30 years old had the highest proportion of involve­
ment (39.9%), followed by participants between 31 and 50 (18.2%). The
elderly group (older than 60 years old) amounted to 12.7%, and par­
ticipants between 51 and 60 came in at 15.2%. The minority consisted of
participants younger than 20 at only 4.0%. Most participants had a
P. Janmaimool et al. Cleaner and Responsible Consumption 12 (2024) 100175

bachelor’s degree (52.21%), whereas those with an education level Table 1

below a bachelor’s degree accounted for 12.48% of participants. Others Questionnaire items.
had educational degrees higher than a bachelor’s degree (25.34% for a Constructs Items Response
master’s degree, and 9.98% for a doctoral degree). Most participants had Categories
an income lower than 15,000 baht (440 USD; 37%). The proportion of Infectious Waste A1: Have you used cotton face masks 1 = Never
participants with an income between 15,000 and 35,000 baht was Minimization (WM) to prevent COVID-19 infection? 5 = Regularly
15.3%, and that of participants with an income between 35,001 and 60, A2: Have you used face masks
000 baht was 19.9%. Other participants had an income greater than 60, produced from recycled materials to
prevent COVID-19 infection?
000 baht (17.7%). Infectious Waste D1: Have you forgotten your medical 1 = Regularly
Collection Awareness face masks in public areas such as 5 = Never
3.4. Ethical considerations (WCA) restaurants, parks, markets, etc.?
D2: Have you lost your in-use face
masks during the day?
This study was approved by the ethical committee of King Mongkut’s
Infectious Waste S1: I place used medical face masks in 1 = Never
University of Technology Thonburi, Bangkok, Thailand on October 4, Segregation (WS) a plastic bag, and seal or tie the bag 5 = Regularly
2022 (approval number: KMUTT-IRB, 2022/0928/252). In collecting before throwing it away.
the data, the participants were first asked to give their consent to S2: Before throwing away used
participate, then informed that their participation was voluntary. antigen test kits, I separate elements
contaminated with biological
material (e.g. the swab, buffer tube
3.5. Data analysis and cassette) from other
uncontaminated materials, and place
All collected data were inspected before the analyses, which were them inside a sealed plastic bag.
S3: Before throwing away used
divided into three parts. First, analyses of descriptive statistics, such as
antigen test kits, I separate recyclable
percentage, mean and standard deviation, were conducted to reveal materials, and throw them away in a
participant characteristics and the values of the study variables. Second, place for recyclable waste.
confirmatory factor analysis (CFA) was performed to test the scales’ S4: I throw away the infectious waste
construct and discriminant validity (Devellis, 2003). Based on the I generated into an infectious waste
bin or container.
measurement model results, validity fitting indexes such as χ2/df, CFA, Perceived Characteristics of Environmental Risks
TLI, RMSEA and RMR were calculated. The factor loading for each item Environmental Impact O1: An increase in the quantity of 1 = Completely
in each study variable was also calculated, with items that had factor Occurrence (EIO) infectious waste, including medical disagree
loading values lower than 0.60 removed (Hair et al., 2010). In addition, face masks and (Antigen-test Kits) 5 = Completely
ATKs, may cause several types of agree
Cronbach’s alpha (α) coefficients, average variance extracted (AVE) and
environmental pollution, such as air,
combined reliability (CR) were determined to test the measurement water or soil pollution.
reliability and validity of each study variable. Finally, the hypothetical O2: An increase in the quantity of
model was evaluated via structural equation modelling (SEM) analysis. infectious waste, including medical
SPSS 22.0 and Amos 23 were utilized for the data analyses. face masks and ATKs, may increase
the quantity of ocean waste.
O3: Animals could be adversely
4. Results affected by an increased quantity of
infectious waste, including medical
4.1. The measurement model face masks and ATKs.
Harmfulness of H1: How severely would an increase 1 = Extremely
Environmental in the quantity of infectious waste, low
First, the fitness of the measurement model to the data was evaluated Impacts (HEI) including medical face masks and 5 = Extremely
via CFA (Thompson, 2007). The results showed that the measurement ATKs, exacerbate existing high
model was acceptable (X2 = 96.434, df = 77, p = 0.066, X2/df = 1.252, environmental problems, such as
GFI = 0.980, TLI = 0.994, CFI = 0.997, AGFI = 0.955, RMSEA = 0.022). global warming or environmental
pollution?
Each item had factor loadings above 0.6 (Hair et al., 2010), with all H2: How severely would infectious
ranging from 0.601 to 0.962 (see Table 2), thereby showing convergent waste affect animal species?
validity. The CR values were between 0.741 and 0.922, which were H3: How severely would infectious
greater than the standard value of 0.7 (Fornell and Larcker, 1981), and waste impact ecosystems?
Perceived Characteristics of Environmental Health Risks
thus indicated good reliability of the latent variable measurement
Health Impact HO1: Improper disposal of infectious 1 = Completely
model. AVE was also calculated to reflect the average amount of vari­ Occurrence (HIO) waste, including medical face masks disagree
ance that a construct can explain in its indicators. A suitable convergent and ATKs, may cause the greater 5 = Completely
validity should have an AVE equivalent to or greater than 0.5 (Hair spreading of COVID-19. agree
et al., 2010). For this study, AVE values ranged from 0.502 to 0.855, HO2: Environmental pollutants
caused by the improper management
exceeding the generally accepted minimum of 0.5 (Fornell and Larcker, of COVID-19 infectious waste may
1981). Finally, Cronbach’s α coefficients were calculated to assess the negatively impact human health.
internal reliability of the measures. The results showed that Cronbach’s Harmfulness of Health HH1: How severely would 1 = Extremely
α coefficients ranged from 0.753 to 0.921, all above the threshold of 0.7 Impacts (HHI) environmental pollutants caused by low
the improper management of 5 = Extremely
(Fornell and Larcker, 1981).
infectious waste impact human high
In addition, correlation analyses were performed to verify discrimi­ health?
nant validity of the variables. According to Pearson’s correlation anal­ HH2: To what extent do you think
ysis, the correlations between the independent variables (EIO, HEI, HIC that human health could deteriorate
and HHI) and the dependent variables (MW, WCA and WS) were sta­ in the long run due to environmental
pollutants caused by the improper
tistically significant (p < 0.05; Fornell and Larcker, 1981), confirming management of infectious waste?
discriminant validity. In addition, there was no multicollinearity issue,
as the coefficient values were not greater than 0.60 (Gao et al., 2017; see
Table 3). Therefore, SEM could be performed.

7
P. Janmaimool et al. Cleaner and Responsible Consumption 12 (2024) 100175

Table 2
The measurement model.
Variable Items M SD Factor Loadings (>0.6) CR (>0.7) AVE (≥0.5) Cronbach’s Alpha (>0.7)

Infectious Waste Minimization (WM) A1 3.132 1.474 0.886 0.922 0.855 0.918
A2 2.841 1.602 0.962
Infectious Waste Collection Awareness (WCA) D1 4.518 0.899 0.934 0.920 0.851 0.921
D2 4.392 0.955 0.911
Infectious Waste Segregation (WS) S1 3.664 1.329 0.662 0.799 0.502 0.791
S2 4.088 1.201 0.724
S3 3.743 1.350 0.828
S4 3.330 1.405 0.601
Environmental Impact Occurrence (EIO) O1 4.386 0.919 0.768 0.821 0.604 0.798
O2 4.180 1.029 0.795
O3 4.205 1.007 0.768
Harmfulness of Environmental Impacts (HEI) H1 4.311 0.958 0.796 0.768 0.526 0.822
H2 4.081 0.985 0.705
H3 3.810 1.134 0.668
Health Impact Occurrence (HIO) HO 1 4.242 0.944 0.778 0.741 0.588 0.753
HO 2 3.877 1.014 0.756
Harmfulness of Health Impacts (HHI) HH 1 3.745 1.053 0.933 0.912 0.838 0.913
HH 2 3.735 1.095 0.898

4.2. Structural equation model assessment
SEM analysis was performed to confirm whether the participants’
perceived environmental risk and environmental health risk character­
istics, as well as socio-demographic characteristic variables (age, income
and education level), affected their participation in sustainable infec­
tious waste management behaviours (infectious waste minimization,
collection awareness and segregation). First, the overall fit of the model
with the data was examined. The results revealed that the model was not
fit with the data, and that perceived environmental impact occurrence
(EIO) and perceived health impact occurrence (HIO) did not signifi­
cantly affect all types of sustainable infectious waste management be­
haviours. In addition, income did not significantly affect infectious
waste collection awareness or segregation behaviours, and education
did not significantly affect waste segregation behaviours. Therefore, to
improve the model’s fit, paths without statistically significant affect (p
> 0.05) were removed from the structural model. Consequently, the
results showed that the model perfectly fit the data.
Several validity fitting indices were also statistically accepted. For
instance, the χ2 value was not statistically significant (χ2 = 78.936; df =
67; p = 0.161), and χ2/df was 1.170, which was not greater than 5.0
(Hair et al., 2010). The GFI value, which was greater than 0.90, indi­
cated a close fit between the observed data and the model (GFI = 0.982;
Hair et al., 2010). The RMSEA value was less than 0.08, which indicated
a reasonable approximation of the data (RMSEA = 0.018; Brown and
Cudeck, 1993). To explain the discrepancy function adjusted for sample
size, the CFI value was calculated, and the result revealed an acceptable
value of 0.998, which was greater than 0.90 (Hu and Bentler, 1999). The
IFI value of 0.988 was also acceptable, as it was greater than 0.90,
indicating the proposed model’s acceptability (Meyers et al., 2006).
Finally, the TLI value of 0.996 also exceeded the acceptable minimum of
0.90. From the SEM, it can be concluded that the proposed model was
statistically acceptable (see Fig. 3).
4.3. Effects of environmental risk and environmental health risk
perceptions on infectious waste management behaviours
According to the SEM analysis results, each type of infectious waste
management behaviour could be predicted by a different set of vari­
ables. For the infectious waste minimization behaviours, the squared
multiple correlations value of 0.40 was derived. This indicated that
approximately 40% of the variance in infectious waste minimization
behaviours could be accounted for by a linear combination of the vari­
ables perceived harmfulness of health impacts, age, income and edu­
cation level (see Fig. 2). Most notably, perceived harmfulness of health
impacts (β = 0.347; t = 8.646; p < 0.001), age (β = 0.466; t = 9.928; p <
0.001) and education (β = 0.310; t = 6.945; p < 0.001) positively and
significantly affected the participants’ infectious waste minimization
behaviours, whereas income (β = − 0.140; t = − 2.810; p < 0.001)
negatively and significantly affected these behaviours. Considering in­
fectious waste collection awareness, the results showed a squared mul­
tiple correlation value of 0.20, indicating that 20% of the variance in
infectious waste collection awareness could be accounted for by the
linear combination of the variables perceived harmfulness of environ­
mental impacts, age and education level. From these results, perceived
harmfulness of environmental impacts (β = 0.434; t = 8.607; p < 0.001),
age (β = 0.098; t = 2.224; p < 0.01) and education level (β = 0.089; t =
2.060; p < 0.01) positively and significantly affected waste collection
awareness. Lastly, the results indicated a squared multiple correlation
value of 0.19 for the variance in infectious waste segregation

Table 3
The results of correlation analyses.
Constructs EIO HEI HIO HHI Education Income Age WM WCA WS

Environmental Impact Occurrence (EIO)

Harmfulness of Environmental Impacts (HEI) .546**
Health Impact Occurrence (HIO) .505** .538**
Harmfulness of Health Impacts (HHI) .518** .513** .580**
Education .087* .051 .062 .010
Income − .022 − .040 − .051 − .092* .492**
Age − .053 − .097* − .020 − .106* .326** .600**
Infectious Waste Minimization (WM) .258** .267** .309** .279** .353** .251** .429**
Infectious Waste Collection Awareness (WCA) .441** .378** .450** .333** .143** .031 .090* .164**
Infectious Waste Segregation (WS) .361** .358** .457** .349** .076 .063 .143** .234** .319**

** Statistic significance at 0.001 level.

* Statistic significance at 0.05 level.

8
P. Janmaimool et al. Cleaner and Responsible Consumption 12 (2024) 100175

Fig. 3. The study’s structural equation modelling (SEM; **p < 0.001).

behaviours. This indicated that 19% of the variance in waste segregation environmental health risk characteristics (threat occurrence and
behaviours could be accounted for by a linear combination of the vari­ severity), as perceived by participants, have the ability to predict sus­
ables perceived harmfulness of environmental impacts and age. Both tainable infectious waste management behaviours; even though many
perceived harmfulness of environmental impacts (β = 0.419; t = 7.657; previous studies have revealed that environmental risk and environ­
p < 0.001) and age (β = 0.180; t = 3.873; p < 0.001) positively and mental health risk perceptions can predict sustainable behaviours (Pahl
significantly affected these behaviours (see Table 4). et al., 2005; Schmitt et al., 2019; Zeng et al., 2020). Surprisingly, the
results did reveal that perceived occurrence of ecological threat to the
5. Discussion, recommendations and conclusion environment and to human health did not significantly affect all types of
sustainable infectious waste management behaviours. These findings
The objective of this stay was to examine how people’s perceived contradict Li et al. (2022), who found that the perceived possibility of
characteristics of environmental risks and environmental health risks, as ecological threat occurrence and threat severity affected the
associated with COVID-19 infectious waste problems, as well as the pro-environmental behaviours of college students in China. This implies
socio-economic characteristics (i.e. income, age and education) affect that people’s understanding of the possibility of threat occurrence to the
their participation in sustainable infectious waste management behav­ environment and human health does not sufficiently encourage them to
iours (i.e. infectious waste minimization, waste collection awareness, participate in all types of sustainable infectious waste management
and infectious waste segregation). CFA and SEM analyses were per­ behaviours.
formed to test the effect of independent variables on dependent This study also demonstrated that both perceived severity of
variables. ecological threat to the environment (harmfulness of environmental
This study demonstrated that not all environmental and impact) and to human health (harmfulness of health impacts) signifi­
cantly affect sustainable infectious waste management behaviours.
Specifically, perceived severity of ecological threat to human health
Table 4 predicted infectious waste minimization and segregation behaviours,
Path coefficient estimate of the revised model. whereas perceived severity of ecological threat to the environment
Paths Estimate S.E. C.R. Beta could predict only infectious waste collection awareness. These results
imply that people are more likely to practise sustainable behaviours if
Harmfulness of Health Impacts → 0.476 0.055 8.646 0.347**
Infectious Waste Minimization
they realize that environmental impacts could affect human health to a
Harmfulness of Environmental 0.362 0.042 8.607 0.434** certain degree. As stated by Lu et al. (2015), people may realize the
Impacts → Infectious Waste environmental impacts caused by their practices, but the decision to
Collection Awareness perform risk reduction measures (i.e. avoidance of practices that
Harmfulness of Health Impacts → 0.346 0.045 7.657 0.419**
potentially generate environmental impacts) is based on people’s
Infectious Waste Segregation
Income → Infectious Waste − 0.100 0.035 − 2.810 − 0.140** awareness of how much the environmental impacts would negatively
Minimization affect their lives. For this study, a higher level of perceived harmfulness
Age → Infectious Waste Collection 0.054 0.024 2.224 0.098* of health impacts caused by the environmental pollutants stemming
Awareness
from a massive amount of COVID-19 infectious waste might have
Age → Infectious Waste Minimization 0.414 0.042 9.928 0.466**
Age → Infectious Waste Segregation 0.096 0.025 3.873 0.180**
increased the participants’ concerns about their health; thus, they were
Education → Infectious Waste 0.511 0.074 6.945 0.310** more likely to take part in sustainable infectious waste management
Minimization behaviours. Lee et al. (2022) likewise found that people’s decision to
Education → Infectious Waste 0.09 0.044 2.060 0.089* purchase sustainable face masks was significantly influenced by their
Collection Awareness
health concerns. Similarly, Verma et al. (2019) reported that

9
P. Janmaimool et al.
individuals’ concerns about health and well-being motivated their
adoption of green purchasing behaviours. Therefore, this study strongly
highlights the importance of individuals’ perceived severity of ecolog­
ical threats to human health in promoting sustainable infectious waste
management behaviours.
Though many previous studies have concluded that environmental
behaviours are influenced by perceived environmental risks (Lacroix
and Gifford, 2018; Slovic, 2016), this study indicated that perceived
severity of ecological threat to the environment only affects individuals’
engagement in infectious waste collection awareness, which, in this
study, was a measure that directly affects the environment. Notably, not
performing this measure (e.g. not disposing of infectious waste in a
rubbish bin but littering) can directly impact the environment. For
instance, the practice like losing wastes in public spaces can directly and
immediately create a negative impact on the environment such as birds
trapped in used face masks or contaminated water due to massive in­
fectious wastes in water resources. Thus, people with high level of
perceived harmfulness of environment impact will try to avoid this
problematic behaviour.
For the other types of infectious waste management behaviours
(waste minimization and segregation), the study found that perceived
threat severity to the environment was not significant. In this way, in­
dividuals’ concerns about their health, which might be influenced by
environmental pollutants from infectious waste management problems,
could more heavily promote their practice of sustainable infectious
waste management behaviours. However, the role of environmental risk
perception, particularly perceived severity of ecological threat to the
environment, cannot be neglected, as it might affect some types of in­
fectious waste management behaviours that directly affect the
environment.
Furthermore, this study found that socio-economic factors signifi­
cantly affect several types of infectious waste management behaviours.
Notably, participant age positively affected all three behaviours, with
the older age group in particular seemingly more active in participating
in sustainable infectious waste management behaviours. Some previous
studies have found similar results (Otto and Kaiser, 2014; Wiernik et al.,
2013), explaining that older people have more experiences with adverse
environmental consequences; thus, they are more aware of environ­
mental issues and more easily decide to partake in environmental be­
haviours. Another possible reason is that older groups might perceive a
higher susceptibility to environmental impacts than younger groups, as
younger people generally have better physical health conditions. Older
people therefore feel more sensitive to environmental health–related
problems, so they are more likely to perform sustainable behaviours to
mitigate risk. This association is further supported by the study’s addi­
tional finding that participants with high perceived harmfulness of
health impacts caused by infectious waste management problems ten­
ded to be more active in performing sustainable waste management
behaviours.
This study also revealed the significant and positive effect of edu­
cation level on waste minimization and collection awareness. This
finding is consistent with Kagawa (2007) and Emanuel and Adams
(2011), who found that people with a higher education level tend to
more actively participate in environmental behaviours. Spending longer
years in educational institutes, people could be more educated about
issues related to environmental responsibilities. Consequently, they
could have more environmental concerns that lead to performing sus­
tainable behaviours effectively (Gifford and Nilsson, 2014; Liere and
Dunlap, 1980). Environmental education in educational institutes is
therefore important to promote sustainable behaviours.
Regarding income, this study found that income only affects waste
minimization (e.g. using cotton or recyclable masks), and negatively at
that. This meant that participants with lower incomes tended to be more
likely to participate in this type of behaviour. Many previous studies
have explained that low-income people are more likely to receive
negative impacts from environmental problems, such as pollution,
10
Cleaner and Responsible Consumption 12 (2024) 100175
climate change and disasters (Hallegatte and Rozenberg, 2017; Inter­
national Monetary Fund, 2017), meaning that they can construct more
environmental concerns and decide to participate in sustainable be­
haviours. However, this reason might not explain this study’s findings,
as income only affected one type of infectious waste management
behaviour (waste minimization), and this behaviour could in fact help
people save money in using daily PPE. For instance, using cotton or
recyclable masks could be less expensive than using single-use face
masks, so the low-incomes may have no choice than this for their eco­
nomic reason.
Based on the results of this study, recommendations to promote
people’s participation in sustainable infectious waste management be­
haviours can be proposed. First, communication about the adverse im­
pacts of environmental pollutants (as caused by infectious waste
management problems) on human health and the environment can be
very influential in promoting people’s participation in sustainable waste
management behaviours. This study’s results showed that perceptions of
the harmfulness of health and environmental impacts as caused by waste
management problems significantly influence these behaviours. Second,
environmental education provided in educational institutes is always
important to garner concern about environmental issues, thus making
people more likely to respond to those issues. While at school or uni­
versity, people should be educated on these troubling topics, such as
climate change, environmental health–related issues and environmental
pollutants. Moreover, younger generations can serve as a target group
when promoting sustainable behaviours, as this study found that
younger age groups are less likely to perform infectious waste man­
agement behaviours.
6. Limitation of the study
Infectious waste management behaviors explored in this study could
be explained by investigated variables 19–40%. There are other poten­
tial variables (such as self-efficacy, environmental knowledge, social
norms, etc.) which are not included in this study. Therefore, further
studies which could cooperate those variables are recommended. In
addition, the result of this study might not be able to generalize to the
whole population of Bangkok city because demographic characteristics
of research participants are different from ones of target population.
This difference can limit the ability to generalize the study results.
CRediT authorship contribution statement
Piyapong Janmaimool: W. Jaruwan Chontanawat: Supervision,
Methodology, Investigation, Data curation, Conceptualization. Sur­
apong Chudech: Visualization, Supervision, Software, Data curation,
Conceptualization.
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.
Data availability
Data will be made available on request.
Acknowledgement
This study was financially supported by the School of Liberal Arts,
King Mongkut’s University of Technology Thonburi, Bangkok, Thailand.
The scholarship number is 2566201. Authors would like also thank all
participants who supplied valuable data for this study.
P. Janmaimool et al. Cleaner and Responsible Consumption 12 (2024) 100175

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