 So, just a few administrative comments before we move to the agenda today. Our physical location is at the Waterbury State Office complex on the second floor in the Ash Conference Room, if anyone wants to come join us. Next week we'll be back at the Agency of Agriculture. We're going to have our meeting on Thursday, July 15th at 9.30 and we're going to be discussing energy use and environmental issues. Just remind folks that we do currently have two positions posted. We have a general council position. That application period closes on July 19th and we have an administrative services coordinator position which closes on July 13th. I wanted to mention that we're going to be holding an executive session today. It's an extended one. We're going to be meeting with our finalists for our consulting position. And hopefully we'll have a decision on that and we can announce who that is relatively soon afterwards once we work out a few of the details. There's two names left that have yet to be named on our advisory committee. Once we have those names we will post that full list to our website. And just with respect to our Executive Director, Bryn Hare, she's wrapping up with Ledge Council I think tomorrow then taking a week off and she'll be starting with us on the 18th. One last thing. I mentioned this last week our physical address for the board itself is going to be changing. It was 12 Baldwin in Montpelier. It's now going to be 89 Main Street in Montpelier. So today we're going to continue our fact finding into some of the priorities that we identified in Act 164 and Act 62. This meeting today is dedicated to effective prevention and education strategies particularly with respect to youth. And then also we're going to hear about advertising and how that's been working in other states. This is an area of particular concern to the board. When I first started thinking about cannabis policy I met with almost every Cabinet Secretary at the time to discuss how an adult youth system might impact his or her agency and its core mission. And from a policy perspective my meeting with Health Commissioner at the time Dr. Chen was probably one of the most challenging for me and really stuck with me. His team was showing me the negative trends that DOH tracks regarding perception of harm of cannabis among middle school and high school students as well as their ease of access. And essentially as cannabis has become more normalized in the country over the past few decades and years the trends were showing that kids felt that A it was not harmful and B that it was easier to get their hands on than some other regulated products like tobacco and alcohol. So Dr. Chen never came on board with the idea of creating a regulatory framework for cannabis in Vermont but he did agree with us at the time that it was time to kind of face some of these challenges and these negative trends head on and he needed the kind of resources in order to do that. So we dedicated in the bill that I worked on 25% of all cannabis revenue to the Department of Health in order to develop prevention programs kind of fill the gaps in those and also counter marketing initiatives. Act 164 dedicates 30% of the excise tax to the Department of Health and it's capped at $10 million. We have a really incredible slate of witnesses today to help update us on some of the trends that we've been seeing in the state and nationally to help us think about the challenges ahead and how the board can meet these challenges head on and importantly what sort of prevention education and counter marketing strategies are effective in this space. Just as a quick aside, a number of witnesses that have been working in this space for decades including Dr. Levine and the Vermont Medical Society could not join us today. I just want to remind everyone who's watching that today really is just the beginning of this conversation and that ensuring a safe rollout of the adult use program is core to our mission as a Cannabis Control Board and we will be revisiting this issue as a board and through our advisory committee again and again. So I'd like to just move to the agenda now. Our first order is to approve our minutes from last week. I'll move to approve the minutes from the July 1st meeting. Oh, second. All in favor? Aye. Aye. Okay. So our first witness that I'm just going to jump right in, I see that Dr. Volanti has joined us. Dr. Volanti is a PhD MPH and associate professor at the departments of psychiatry and psychology at the University of Vermont. I've known her from her incredible work that she's done to help our legislature craft good policy and I consider a foremost expert in the state and probably the country on issues related to young adult tobacco use, cessation, prevention, and counter-marketing. And now that we're starting to collect reliable data in other adult use states, I think she's actually started to observe some trends with respect to cannabis usage. So Dr. Volanti, I don't want to take up any more of your time, but if you could maybe just introduce yourself for the record quickly and help us on these issues. Of course. Good morning. Thank you for having me. My name is Andrea Volanti. I am a faculty member at the University of Vermont and the work that I do is largely focused on youth and young adult tobacco use, though I've expanded my work into substance use more broadly as we've had more recreational cannabis coming through the U.S. So I will share my screen and use- We can see that. Thank you. Okay. So are you seeing the slides? Yep. Yeah. Okay, great. So this is my disclosure slide. I am funded by the National Institutes on Health, the FDA, HRSA. I will not be talking about any, I don't have any industry funding. I'm not going to be talking about any off-level medication use, et cetera. So just again, my areas of focus are kind of three-fold. First youth and young adult substance use and cessation. I oversee the PACE Vermont study, which I'll talk about more during this session in collaboration with the Vermont Department of Health. We have funding for that study from the National Institute on Drug Abuse. I've also been doing work on socioeconomically disadvantaged young adult smokers and improving their cessation. I do a lot of work in the field, a new field of tobacco regulatory science that I think is very applicable to the world of cannabis regulatory science, which is also emerging. And I am very interested in methods and measures and how we do better in our data collection to evaluate and inform our public health policies and programs. So why is a tobacco researcher talking to you about cannabis? One of the reasons is that we see a lot of parallels between what might be coming for the cannabis environment and the tobacco industry, especially as it relates to the tobacco industry participating in the cannabis environment. And so this is a paper that came out in 2014 that documented a number of documents that the industry had produced through the 1970s and 80s about how they could capitalize on legalized marijuana. This is a more recent opinion piece in the Boston Globe from a few months ago, just documenting that the tobacco industry is really engaged in this field and is investing in cannabis companies and in products that could maximize their distribution of cannabis. So what I'm going to talk about today is kind of two broad, broad buckets. First is looking at surveillance in adolescents and young adults, looking at data from the US broadly, and then looking at data in Vermont. And then also just more briefly, since there's less data on this, talking about cannabis marketing and counter marketing and kind of giving broad strokes on where I think we need to go in our state. So overall, past year initiation of substance use by age group, you can see here for cigarettes, alcohol, and marijuana. This is data from 2019 from the National Survey on Drug Use and Health. And what you can see here is that the youth, the blue bars who are 12 to 17 and the young adults age 18 to 25 are the groups that have the largest initiation of past year substance use. And you can see these numbers for cigarettes, alcohol, and marijuana. There's very little initiation after the age of 26 in this data. Additionally, the mean age of first substance use among past year initiates generally falls within the young adult age group. So generally, we thought of youth age 12 to 17 adolescents as the group where most initiation starts. What we can see here is that it actually spans adolescents and young adulthood with most of initiation occurring across substances in that young adult group. So broadly, we've been looking at trends overall and thinking about how the order in which substances are used may influence uptake of other products. And so this is data again from the National Survey on Drug Use and Health from 1976 through 2016, I believe, looking at the likelihood that an adolescent would try marijuana before or after alcohol. And what you can see here, if you look at this blue, the kind of turquoise colored line on the bottom, you can see that over time, this line is coming up a bit. And that's the line for trying marijuana before alcohol. So over each year, there's an increase in the odds of trying alcohol after marijuana compared to before marijuana, showing that marijuana is increasingly the first substance tried. This is a similar graph for cigarettes. You can see the line is sort of more steeply sloped, showing that marijuana is increasingly tried before cigarettes as well. So why does this matter? Why do we care about marijuana use in young people? First is the impact on health, and these are some of the health effects that are noted in the 2017 National Academies of Science, Engineering, and Medicine report. The one thing I just wanted to highlight is some emerging data on the relationship between cannabis use and suicidality that just came out a couple months ago. This is from the journal JAMA Network Open, and this is a paper that was led by sort of leadership in the National Institutes on Drug Abuse. And what you can see here is this is sort of partitioning out how cannabis use, cannabis use disorder, major depressive episodes, that's what MDE is here, and suicidal ideation are related. And what we can see across all of these bars is that for cannabis use disorder, for example, on the left here with or without a major depressive episode is associated with suicidal ideation. So cannabis use disorder associated with suicidal ideation, additionally daily and non-daily use associated with greater suicidal ideation. And then secondly, is thinking of how, in addition to health, how marijuana use may impact the development of substance use disorder. So just use generally translating into an actual use disorder. And so this is data, again, from leadership at the National Institutes on Drug Abuse. This, again, came out just a few months ago looking at the proportion of lifetime cannabis users who were aged 12 to 25. And the proportion of them that had reported a cannabis use disorder diagnosis in the past year. And what you can see here is that overall 15% of lifetime adolescent cannabis use disorders report past year cannabis use disorder. And 10% of lifetime young adult cannabis users report past 12-month cannabis use disorder the longer the time since their initiation as these numbers go out to the right, the higher that proportion. So this is a significant concern that we are likely to see some change in cannabis use disorder with increased trial and use. And then third is, again, this relationship between substances. So the impact of marijuana use on trial or use of other substances. In youth, we know that this relationship is generally bi-directional. Young people who try one product are more likely to try another. In adults, we see that cannabis use is associated with increased initiation, persistence, and relapse to cigarette smoking. And in adolescents and young adults, we also know that cannabis use is associated with alcohol dependence and alcohol-associated adverse effects. And this is a study from a few years ago looking at the ways in which using these products together, specifically cannabis and tobacco, can be related to heavier use and poorer functioning. So one of the things I want to highlight here is that substance use does not exist in a vacuum. So all of these substances are being used together. As we are thinking about cannabis prevention policies and intervention opportunities, we need to be thinking about how that affects the entire ecosystem of substance use, including tobacco and alcohol. This is a paper that we did a few years ago using data from a large national sample called the Population Assessment of Tobacco and Health, where we looked at patterns in substance use. And I apologize that the animation didn't work here for you to see the patterns. But the thing that I wanted to highlight here is that if you look through this list of the top patterns of substance use, what you can see here is that there is no marijuana-only group. There's alcohol and marijuana. There's alcohol cigarettes and marijuana. There's alcohol, cigarettes, marijuana, and cigars in these top 10 patterns, but not a marijuana-only group. So again, just keeping that context and keeping awareness of that context of poly substance use. So how does Vermont compare to the United States? In terms of past month use, these are data for adolescents and what you can see here is Vermont in the blue lines compared to the U.S. in the red lines. And for each of the substances, tobacco, past month tobacco, past month alcohol, past month marijuana use, we are higher than the U.S. estimates overall. So that's a consistent pattern in our adolescents. Similarly in young adults, we have higher past month prevalence of tobacco, alcohol, and marijuana use in Vermont compared to the U.S. So we're starting off in a different place than other states that have legalized cannabis sales. Similarly, for harm perceptions, we see that on the left, we're looking at the perceived harm, perceiving great risk from smoking one or more packs of cigarettes per day. And you can see that Vermont and the U.S. look very similar. When we look at the prevalence of great risk from binge drinking once or twice a week, you can see that Vermonters are actually the lower line here, meaning that we have lower harm perceptions of binge drinking or of smoking marijuana once a month in adolescents compared to the U.S. So we have higher use. We have lower harm perceptions. We see this pattern consistently in our adolescents and again in our young adults. Why does that matter? Well, we have some strong data in the tobacco literature that lower harm perceptions of a product predict subsequent tobacco product use so that there is a relationship between having low harm perceptions of a product and initiating or trying that product. We know in cross-sectional studies that greater perceived risk of marijuana, so having higher harm perceptions of marijuana, is actually protective. So same relationship, higher harm perceptions means lower use in youth. But again, as I mentioned, when we're thinking of other states that have permitted cannabis sales, what you can see here is the date that it was passed, the opening date of the first retailers, and then national data from, again, the National Survey on Drug Use and Health that I pulled from right before that policy went into place and then right after that policy went into place. So this is a short-term look. But the thing I really want to highlight here is our state is starting out with a much higher prevalence of young adult past month marijuana use. So you can see we're at almost 40% even pre-policy. None of the states, even in their post-implementation period, have reached that level of past 30-day use, past month use. So this is an important context for us to have in thinking about whether we have we reached a ceiling where we may not see more uptake or is this going to dramatically change when we may see even higher levels here. With respect to what's happened in other states that have legalized cannabis sales, Washington State saw a decrease in perceived harm of marijuana and an increase in frequent marijuana use in adolescents, post-legalization. In Colorado, they documented no effect on perceived harm or marijuana use in adolescents. But again, as James noted, the perceived ease of access to marijuana increased in adolescents. And then in Oregon, the data that I have here for is for undergraduates, college students, young adults. They saw an increase in past 30-day marijuana prevalence and a decrease in past 30-day tobacco use. And that didn't differ by age, whether they were under or above age cutoff for legal sales. National data on evaluations of recreational marijuana legalization are fairly limited. But the couple that exist, one of them, again, used the National Survey on Drug Use and Health looked at everyone ages 12 and above and documented a small increase in past year cannabis use disorder in adolescents as a result in states where recreational marijuana had been legalized. They saw no impact on young adults. And they saw an increase in frequent marijuana use and in cannabis use disorder in adults age 26 plus. So again, cannabis use disorder showing up increases in adolescents and in those age 26 plus. Data on college students using a national survey of college health showed that states with recreational marijuana legalization had increased past 30-day marijuana use prevalence. They saw that in particular subgroups, including females. Students who were living off campus and those aged 21 plus. And in another study, they found that the relationship between recreational marijuana legalization and other substance use. So they were looking at tobacco, alcohol, prescription drug use, et cetera. They found decreased binge drinking in the states that had legalized recreational marijuana in those age 21 plus. And but they also saw increased sedative misuse in younger participants. So a lot of the work that I do at currently is with the PACE Vermont study. And PACE stands for Policy and Communication Evaluation. This is a study that is a partnership. It was initially funded by the Vermont Department of Health and with a grant from Pilot Funds from the UVM Cancer Center. And it has now been funded by the National Institutes on Health. The goal of our study is to understand the impact of state level policies and communication campaigns on substance use beliefs and behaviors in younger Monters. So our study spans ages 12 to 25. We conduct online surveys of young people almost quarterly. And we are able to be really flexible with our instrument. And we work together. I work very closely with the Department of Health on the items that we include so that we can make sure that we are tracking and also evaluating some of the state efforts that are in place and coming into place. I want to give you a bit of background on how we think of how these things relate and how we structure our data collection. So in terms of that relationship between harm perceptions and use we think that policy has an impact on harm perceptions. It also likely has an impact directly on behavior as that relates to access and many other many other facets of actual behavior. Communication efforts linked with policy also have an impact on harm perceptions. And again from harm perceptions we think that this is where we're changing norms attitudes and behavioral control or decisions about cost benefit of using a substance. Those things then relate to intention to use and then ultimately use. So when we're thinking about harm perceptions we're thinking of that as a marker for a pathway that leads to potential curiosity or intention to use and ultimately use. As I mentioned we're able to track things in fairly real time. So we launched the Pace Vermont study in the spring of 2019. It was about a year after the possession policy came into effect. So we had a number of items related to policy awareness and just being able to look at how policy awareness differed within our sample. We have an opportunity at this point to be able to look forward and prospectively evaluate how policy how the recreational policy may impact beliefs and use. But we've also taken advantage of the timing of our studies to evaluate the potential impact of the e-cigarette excise tax the ban on online cigarette e-cigarette sales tobacco 21 that came in in the fall of 2019. And then we had the COVID pandemic and we have data essentially spanning a year between pre-COVID and post-COVID. So we have the the numbers that are filled in solid orange here we have collected. We are currently in the field with wave 7 and we have one week left on that so we'll be closing that out soon. And then we have funding to complete two more waves of data collection in the fall and winter of this year. One of the things that we've been really happy to see is that our sample looks pretty close to state estimates from national surveillance tools. So this is these are comparisons the orange dots are Pace Vermont the kind of darker red dots are from the National Survey on Drug Use and Health estimates for our state for a similar time frame. And what you can see here is these dots are very close to each other for cigarette use alcohol marijuana use in both teens and in young adults and that just gives us greater comfort in making statements and and drawing conclusions about the way that our policies and communication efforts might be impacting Vermont teens and young adults because our data look fairly similar to the national surveillance systems that are in place. So one of the things that we asked about in our first wave of the Pace Vermont study which was in 2019 was among young adults what their beliefs were about marijuana. And what you can see here is the great risk from weekly marijuana use that's sort of similar to what we see in the national data for the great risk perceived harm of monthly marijuana use. It's about 8 percent. It's I think a little tiny bit lower in the national sample but that's for weekly versus monthly use. So we're we're on track there. We're on par. You can see here that there is a large proportion of the sample that believes there's a slight risk or no risk from weekly marijuana use. And then we included items that were you that were being targeted in potential campaigns. Regular marijuana use during early years of life can negatively affect attention. Approximately one in 16s who start using marijuana before age 14 develop addiction. Teens who use marijuana have lower academic performance and worse job prospects. Teens who use marijuana weekly or more have twice the risk of depression. And then we also asked a question about what substance in marijuana makes a person high. Just with the understanding that there was that CBD was becoming much more prevalent in the market. And so we have the data here you can see the majority of young adults reporting 80 percent that regular marijuana use can negatively affect attention. About half agreeing with the addiction statement approximately one in 16s who use before age 14 develop addiction. Less than half reporting agreement with lower academic performance and worse job prospects. About 60 percent reporting the relation agreement with the statement about weekly marijuana use being associated with depression. Additionally we asked sort of relative perceived addictiveness of substances. We asked about nicotine caffeine alcohol marijuana cigarettes electronic vapor products and heroin. And we asked people to rate these on a scale from not at all addictive to extremely addictive. That what we did with this and this is work that my doctoral student Julia West has been leading. We looked at how those beliefs cluster together. So we used an analytic technique called latent class modeling to really put people together who responded similarly. And what we found is that there were kind of four big groups of young adults youth and young adults. There was about 30 percent of the sample who reported that everything all of these substances were highly addictive. So across the board they generally reported that everything was highly addictive. We then had a class that was largely defined by reporting that alcohol was moderately addictive and that marijuana had low addictiveness. And that was the bulk of our sample. So that was 60 percent of our sample reporting low perceived addictiveness of marijuana. Then we had a group that was sort of a bit more mixed and we had a group that generally rated everything as low perceived addictiveness. What was interesting to us is that older as you got older you were more likely to move from that high perceived addictiveness class to the group that had the low perceived addictiveness of marijuana. So as people aged as they got to about age 18 like 17 to 18 there was a real switch and there was a higher proportion of people in that low perceived addictiveness of marijuana group. The low perceived addictiveness of marijuana group this class 2 also had higher ever electronic vapor product use marijuana use and alcohol use than the high than the high perceived addictiveness group. And they also had higher past 30 day tobacco marijuana and alcohol use than the class 1. So again this is another way of us getting at that relationship between harm perceptions and use to understand how we might target communication efforts. In work that I had done in a national sample of young adults several years ago as we were seeing cannabis legalization rolling out across the country we added some items in about support for legalization efforts and predictors of intentions to use these products. So what we saw was that about 40 percent of our national sample of young adults favored legalizing marijuana and 14 percent indicated that if it were legalized they would use it more frequently. So this again as I mentioned we were coming into the field about a year after the state marijuana policy had changed. So we asked all of our participants to report which of the following best described Vermont's new marijuana law and we asked them to select all that apply and we identified correct responses as those who reported it was legal for people to 21 plus to use that it was allowed for medical use that they may own up to two plants but not that it was legal it was incorrect if they said that it was legal for anyone to use that they could use in public or that it was legal to sell. And what we saw was that about 60 percent of young adults in Vermont could correctly describe the policy that was in place. That still leaves about 40 percent who could not correctly describe the policy in place. Probably not surprisingly those who had ever or who had used marijuana ever or in the past 30 days were more likely to have correct knowledge of the policy but younger non-white and less educated participants were less likely to have correct knowledge about the policy. So for us that highlighted that there may be some groups that we need to target intervention prevention efforts toward to make sure that everyone understands equally the policy in place and the implications of the policy. Additionally we did see some relationships between policy knowledge knowledge awareness of the state policy and some of these harm perceptions. So people who reported that the perceived harm was of weekly marijuana use that there was only a slight risk compared to no risk those folks were more likely to report correct knowledge of the policy. Those who reported agreement or don't know with the marijuana and attention item more likely to have correct knowledge and a couple of other relationships here those who could correctly identify what substance in marijuana makes a person high again more likely to report correct awareness report awareness of the policy. We also track behavior over time and you can see this is over a six month period. The graph on the left is the prevalence of electronic vapor product use or vaping e-cigarettes generally with nicotine and and this is on the right the prevalence of marijuana use by age group. This is particularly interesting to us to track over time because between summer and fall was the time during which e-cigarette and vaping associated lung injury epidemic was taking place. You may remember Ivali it was initially attributed to vaping products and later was was largely attributed to vitamin E acetate in in informally obtained marijuana vaping products. So we're just sort of interested to track whether that had any impact on use over time. And what you can see here is the bars represent ever use the red in youth and the orange in young adults and the lines represent past 30 day use. And really what you see here is the past 30 day use is pretty flat for both of our age groups. So we didn't really see much change over this six month period. But what I do want to highlight is that even in a short six month period we're seeing quite a bit of initiation. So in our youth electronic vapor product use we see about five percent initiation over a six month period. We see almost nine percent in our young adults. Similarly for marijuana use we see about a five percent initiation over a six month period in youth and about four percent initiation of marijuana use in in young adults. This is data that really these are data that really aren't currently available in any other place. Most of what we have is some sort of retrospective recall. This is actually being able to follow people forward and track their change in behavior over a short term period. We also asked in as we're interested in the Valley about last time you vaped what was in the mist you inhaled and interestingly you can see here that the proportion reporting that they last vaped nicotine sort of decreased a little bit but the proportion reporting that they had vaped marijuana or hash oil increased. We also asked among past 30 day users whether they had quit or cut down in the past year. And what we saw was that a much higher proportion of electronic vapor product users tried to quit or cut down compared to marijuana users. So there's a fairly small percentage of marijuana users who had tried to quit or cut down. And the reasons that they endorsed those who were trying to quit or cut down on vaping nicotine had a high proportion of them reported health money or cost 61 percent 41 percent reporting freedom from addiction. What you can see here is that the top three reasons for quitting or cutting down on marijuana there was not as there was not as a pattern here that was as decisive as the vaping nicotine pattern. So kind of a third a third a third saying other was their top was the top reason endorsed money or cost and health was kind of down on the list only 25 percent of people highlighting health as a reason for quitting or cutting down on marijuana. So again as I mentioned we had our three waves of data collected in 2019 and then about a year break until we got data in 2020. And so that that this is essentially a period that is a one year period straddling COVID in the middle. And so what you can see here is tracking past 30 day substance use we're seeing it's it's generally remained flat. But we did ask specifically among among youth and young adults who had used a substance in the past 30 day how their substance use had changed since the start of COVID. And generally we saw a pattern where about 40 percent stayed the same about and then like 15 percent to 30 34 percent decreased and then a proportion increased. And the thing that was interesting to me is that marijuana use was the one that really stuck out here as the substance that had increased in past 30 day users during COVID. We also asked this is data that we just collected this spring again kind of updating our harm perceptions on related to weekly marijuana use. And if you kind of squint your eyes what you can see is that the red bars which are the youth generally have higher harm perceptions which is what we would hope to see that's what that's what we know is protective against use. The young adults generally have much lower harm perceptions of marijuana use. We asked a different series of marijuana beliefs in spring of 2021 and this is again data just from that we collected in April of this year showing that there is a high proportion of youth and young adults who agree or strongly agree with marijuana can be addictive. Marijuana use affects a person's timing movement and coordination which can harm athletic performance. Marijuana use can affect mental health including depression and anxiety. Marijuana use can affect performance in school or at work and driving while high on marijuana can result in slower reaction times lane weaving and lack of coordination. Interestingly the the item that they did not endorse very strongly was most studies on the relationship between marijuana and health were done when THC levels in marijuana were much lower. The majority of participants here responded don't know. So in terms of again just contextualizing so we have this really high percentage of young people reporting you know beliefs that are consistent with the you know understanding the potential health harms or impact on cognitive or performance that marijuana may have. But again we still see this higher proportion of youths and adolescents and young adults so there there is some sort of disconnect that we're going to have to bridge to reduce use in young people. So what works to prevent substance use in young people. We have a lot of evidence from the tobacco world. This is information from the community guide to preventive services. What you can see here is comprehensive tobacco control programs smoke free policies interventions to increase the unit price for tobacco products mass reach health communication interventions. All of these reduce initiation of tobacco use and are recommended. What comprehensive tobacco control looks like is a coordinated effort with a central administration and management state and community level interventions health communication interventions cessation interventions and surveillance and evaluation that's always monitoring the progress and able to be responsive and make tweaks to those programs. One of the things I wanted to highlight here is just e-cigarette laws that have come into place in Vermont. I think a lot of this mirrors some of what will be present for cannabis sales prohibiting use in worksites restaurants and bars we call that smoke free policy requiring a retail license to sell e-cigarettes over the counter banning self-service displays or vending machines of the products restricting sales to those age 21 plus and having attacks on the product. So all of these things in place for e-cigarettes as I understand it these things will be in place for cannabis as well. We do have effective national tobacco prevention campaigns. These are two examples the Truth Campaign and FDA's real cost campaign. These are recent ads and in Vermont we have a successful e-cigarette prevention campaign which we've actually been evaluating using the PACE data. For alcohol there are also a list of preventive services that are recommended and I wanted to just highlight these because some of these seem to be more related to sales taxes etc. Though there is one here related to screening and brief intervention to reduce excessive alcohol consumption and also again enhanced enforcement of laws that prohibit sales to minors are recommended. For cannabis there's nothing yet. There's no community guide for cannabis so that's that's where we need to start building the evidence base. So if we think about comprehensive cannabis control looking like tobacco control I want to just take a minute to think about the health communication intervention piece. So in the 2012 Surgeon General's report on preventing tobacco use in youth and young adults one of their major conclusions was that advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults. And I highlight this because there is a really strong language and evidence synthesis process for these reports that they don't use the word cause unless there's a lot of evidence to back it up. They use the word cause with all of these diseases that are caused by cigarette smoking. So I just wanted to make that connection as we think about the ways in which there's really nascent data on cannabis marketing and youth use because there hasn't been a retail market. Until you know a decade ago or so. So we have a couple of studies that are showing that youth living in states with legalized retail cannabis that things that we know are associated in our tobacco literature liking or following a business on social media owning or wearing cannabis branded merchandise having a favorite favorite brand those are associated with use. Seeing billboards are correlated with cannabis use disorder. Seeing billboards owning or being likely to own branded merchandise having a favorite brand again associated with weekly cannabis use among among youth. So similar similar patterns that we see in tobacco but again that this is new evidence that's emerging at this point. I just also want to highlight that marketing comes in many forms. So we may be thinking about what's happening at the point of sale or what's going to show up in magazine advertisements or in seven days or somewhere else. But we are seeing a tremendous growth in consulting for social media marketing of cannabis companies. You can see here these are products that were featured in a recent New York Times article that are packaging that looks a lot like candy packaging for cannabis products. This is a billboard from weed maps on legalized cannabis and then on the bottom right is the use of influencers on social media to promote cannabis. So there are many ways in which marketing occurs and the other thing I wanted to just highlight was that for cigarette marketing expenditures the bulk of those happen at the point of sale with price discounts. So we think of all these things being related to marketing and we would likely think magazine advertising mail advertising outdoor advertising. Those are really a small proportion of the tobacco marketing expenditures. The bulk of it is in price discounts. So that's something we may want to keep our eye on. And just again 7.6 billion dollars in 2019 spent on cigarette marketing alone. All of these things work together product design packaging and labeling marketing social acceptability the sensory experience they all occur from the product level to the society and they're all inextricably linked. It's really hard to identify each piece. They all play together. But one of the things I wanted to highlight was this idea of health claims on a product or labeling and its relationship to lower harm perceptions. So these are a couple of images I pulled from the Internet. One is a product and they don't know that you can read it but it says uncut additive free native cannabinoid and terpene ratios whole plant derived. And then you can see here the organic product label. This is similar to these are tobacco cigarette ads from this year. You can see plant based menthol. You can see this relationship to growth and growing and organic tobacco. My colleague Jenny Pearson will be presenting later today. We've collaborated on a number of studies that document that these kind of claims organic natural additive free they they result in misperceptions of harm of the product. In terms of cannabis counter marketing I came across an FTC driven campaign called Operation CBD Deceit about the health claims related to CBD. There as far as I know is a national cannabis counter marketing effort in place now. What happened in the National Youth Antidrug Media campaign in the 90s was actually that they found that exposure to the ads for that campaign resulted in pro marijuana cognitions and greater initiation of use. We call that a boomerang effect. So it happened the opposite of the intended effect. It actually increased use in young people. I think as a result of that very few states have launched mass media public education campaigns that accompany their cannabis sales policies to date. None of them have published any outcome evaluation data. Colorado had an initial counter marketing effort called Don't Be a Lab Rat that was sort of pulled. They have another one in place. But as far as I could tell there there are no evaluation data available to look at the impact. A couple of the studies that I've been involved with on anti-marijuana messaging looked at print campaigns one called Do the Math and the other called Spread the Facts. We compared three different topics within these messaging campaigns that were similar across. So we had messages on cognitive performance messages on driving and messages on health harms. And we did kind of two parallel studies one that just looked at self reported response to the messages and then one that brought people into the lab exposed them to the messages and tracked their eye tracking their heart rate their skin conductance as a way to understand or better capture potentially their response to the messages. So in these two studies in this self report study we saw that that message liking and perceived harm were associated with effectiveness of the message perceived effectiveness of the messages and that these the messages that had greater negative affect and lower positive affect something that like a fear appeal that would raise concerns about health those were those were correlated with higher perceived effectiveness of the message. In the lab study we used heart rate against skin conductance facial action coding and their self reported measures. We found that the driving themed messages were sort of the most effective. Had people had the greatest sort of resource allocation were paying attention and most positive emotional response to those messages. Vermont has a number of programs in place right now Outlast parent up I believe they're launching Let's Talk Cannabis. We are working to collect data on these at many waves of our Pace Vermont study tracking awareness exposure liking and potential impact on behavior. This is an opportunity for us to evaluate the impact and inform future efforts for the state. So where do we go next. First I just want to highlight that the status quo for prevention and cessation is that these remain largely grouped by age so we have prevention interventions that address adolescents and then we have cessation interventions that address adults who are potentially already regular users. Our young adults really fall through the cracks. We don't have good programs in place to support them on either side. So why does that matter. Well young adulthood is the period during which people attain the legal age to vote. They marry by tobacco products and again alcohol and cannabis products potentially. They move from high school to college or work. They move potentially out of their parents home. This is the developmental period where adult health behaviors are established. So if we're thinking about now we have consistency across tobacco alcohol and cannabis where there is an age cut off at 21 we really need to age up our prevention efforts to cover that full 12 to 20 at least age group if not range through the full age group of young adults to be most effective. And then the other piece is thinking about how we address cessation and how we offer treatment opportunities to adults or even to youth who want to reduce or or quit. So in summary we need to address adolescents and young adults in our prevention work. We can't just limit it to youth. We also need to think about how our prevention strategies may have impacts on quitting or cutting down on marijuana use. That's what we see in tobacco use. The interventions that impact initiation also impact cessation. We need to create linkages so our public health our public education our health communication our point of sale messaging we need to have the health resources listed so treatment resources or other information listed and available for a potentially larger pool of people. And we also need to think about what comprehensive cannabis control looks like. How do we develop and coordinate novel surveillance treatment and prevention efforts and ensure that marketing does not induce misperceptions. I also just want to think a little bit about how does prevention what are we talking about with prevention and some of the work that I've been doing has been about how we could even think about this period between experimentation and progression to regular use as trying to prevent the escalation of use not just losing people if they try a product which is sort of how we think of prevention now but how can we address use over the life course to have a better greater impact on public health. So we continue to have challenges with addressing co-use of substances. We need to increase reach and efficacy of our prevention interventions into young adulthood. We also need to improve reach efficacy and uptake of treatment interventions in young people. Thank you so much for having me. Happy to answer any questions. Thank you so much for that presentation. We're very fortunate to have you with us. Are there any questions for Dr. Volunti. I have a couple of questions. One of the slides you showed talked about the like the perception of harm and I think it went from 18 to 25 and I'm wondering if we know the difference or the perception of harm over time. So between 18 and 21 and 21 plus if that changes that you know time where someone is is now legal to use or legal to purchase. That's a great question. So the the major as I've mentioned multiple times the major data source for that is the National Survey on Drug Use and Health and really the the way that they report is in those bigger buckets. There I think you have to get access to a restricted data file to look at that difference by year of age. That's something certainly we could try to look at and we could look at that in our PACE data as well and just see if there is a jump. Generally we do see a change in use between age 17 and 18 and so that that would be a great a great thing to look at is whether the harm perceptions have a jump at that point as well. And my other question is you talked a little bit about the type of information that should be available and we'll be working with the Department of Health on a you know on a labeling for that. And I'm wondering what you would suggest and what other information should be available when someone purchases particularly if they're bringing it home to a home that has youth in it. Yeah I think that there is you know we've we've dealt with this largely for e-cigarettes with the potential poisoning concerns for for youth and making sure that the products are child safe and packaging and all of those aspects of it. Warning labels is something that I think we will need to do some testing on to see what are the messages that resonate and that that's been a struggle in the tobacco world where we've had really small small warning labels on the product for decades and we're just now getting to a point where we can have a larger text-based warnings or even graphic warnings. So that's something I think we need more research on but generally having a graphic warning label is the best case scenario. Dr. Vellante just following up on that exact question have you seen how effective the kind of the large like 50 percent of the packaging and the graphic labeling has been in other countries that allow that. Yes. So the the the sort of gradation is the littlest label is the least effective as you have a larger text only label you have more impact on you know on cessation and reducing use of the product and then as you add the graphic warning label that becomes even more effective. So worst case scenario is a little tiny label best case scenario is a graphic warning label. Dr. Vellante thank you so much for being here your presentation was very insightful question and this was something that was kind of touched or teased upon throughout your presentation and I recognize this might be outside of your scope or your research because this was about cannabis alcohol and tobacco but I am curious about the correlation with opioid use. I know we have an opioid issue in Vermont and around the country so I'm interested in you know real or perceived harm real or perceived access and the correlation in cannabis or in jurisdictions that have a legal regulated cannabis market and how you think about opioids you know again whether that's perceived harm real harm perceived access real access and if you don't if that's not in your wheelhouse I would love to be steered in some directions from you whether that's data or other folks that we can speak to. So I've only seen one study that has addressed the impact sort of what I would describe as sort of a substitution effect. How does the presence of recreational cannabis impact substitution of other products and that study showed reduces of reductions in binge drinking increases in sedative use no impact on opioid use. I did come across some weed maps billboards though that are going up talking about the relationship between recreational cannabis being in place and lower opioid use. I'm not sure whether we have much data on that. I can certainly look into it and see if there's anything more and get back to you but I don't know that we know that these substances are poly substance use is a dominant pattern. So people who are using one substance are using another. I don't know that these are directly substitutable for each other. Great certainly understand and appreciate that. Thank you and unfortunately we can't have billboards here. Right right right. One more question. You highlighted that kind of that gap in young adulthood and how you know folks moving out of their parents house so on and so forth kind of get you know slipped through the cracks when it comes to a lot of you know these types of resources and conversations. What do you think I know we pepper or chairman pepper and Julie touched upon packaging and labeling but what can the board do from an educational perspective to help that specific group of people that I guess 18 to 21 group make an informed decision recognizing that you know they shouldn't be using this product legally until they are the age of 21. So that what we've seen in the tobacco world is that as we make our campaigns more appealing to an older group so older adolescents and young adults it remains effective for youth. So I think some of this is retargeting our educational efforts to resonate with that age group doing focus groups with that age group developing content to target you know what's coming up and what is salient to our young adult group with the expectation and obviously continuing to do that work in youth as well but understanding that generally youth are looking up to young adults that and those messages become sort of aspirational for them. So we're likely to have an impact across that whole age group that is actually what the truth campaign did several years ago when it relaunched was it aged up its targeting to go 15 to 21 rather than 12 to 17 and they've been effective there. Yeah and I would imagine you know there's an illegal market for I guess approximately a decade in other jurisdictions and youth that are in that kind of put falling through the crack age group were the ones that you know were 12 years old 10 years old when that started to happen so I think it'll be interesting how that involves over time. Yeah. Thank you so much. I've just got one quick question for you. I'm so thrilled to see that Pace Vermont exists. You know one of the recommendations from Colorado when we as a state first started thinking about tax and regulators you need to collect your baseline data right now you know you can't wait until after there's retail sales so I'm thrilled about that. I'm curious how effective and maybe it's too soon has the e-cigarette excise tax been on either usage or sales have you have you seen any results from that that you can share. So it's a little hard for us to tell because those policies so there was the tax the ban on online sales and then Tobacco 21 came into effect within three months of each other. So it's it's hard to sort of disaggregate where the effect was. But what we did see was that between the summer and the fall so the summer is when the tax and online sales came into play and then the fall was when Tobacco 21 came in we saw that ease of access to tobacco products went down in youth which is what we would have hoped to see and what we saw even in that short three month period. So I think we may see these impacts on access to use. I don't know that we have enough granularity. I don't think we have you know everything happens quickly together so I don't think we can parse which policy had which effect. Right. Well just I mean I've got a number of questions here. We're running a little short on time. Is it right with you if we post your slides to our website. Yes. OK. All right. Great. Thank you. And you know we're just I feel very fortunate that we have you here in Vermont and with the cannabis board and you know you know you're probably a very busy person but you know our Department of Health has a lot to take on in this with this change and I hope that we could look to you as we as we kind of chart a path forward. Absolutely. Happy to be here. Thank you. Great. Thank you so much. Thank you. So our next witnesses today are are they going to present together do you think they're from prevention and work Vermont. We're trying to get them set up. I think that Cindy is the lead presenter but I think Cindy Jessica and Kate could all turn on their cameras at the same time. Yeah I just made you all presenters so you should should have presenting ability. Well great. Thank you all so much for joining us. You know if I would leave it to you I guess Cindy to kind of manage how you want to present to us and I think we have about an hour scheduled. Yes. Cindy I think you're muted. Thank you for having us. Jessica is going to start us off and is going to share our PowerPoint. Can everyone see our slides. Awesome. So thank you for having us. I'm Jessica Summer. I am the Operations Director for Prevention Works Vermont and I'm also the Executive Director for the Milton Community Youth Coalition. I have more than 15 years experience working with youth between schools and public library settings and prevention work and I have six years of prevention experience here in Vermont. And I've most of that has been with youth and I'm now the Executive Director of the Community Coalition up in Milton serving Chittenden County. Cindy Hayford is the Director of the Deerfield Valley Community Partnership in the Wilmington-Winningham area. She has more than 40 years of experience working with youth 16 as a teacher and 24 leading a community coalition focused on preventing youth substance misuse and promoting healthy communities. And Kate Nugent is the Executive Director for the Winooski Partnership for Prevention. She has more than 20 years experience as an educator and in nonprofit management and leadership and more than 12 years now as the Executive Director of the Winooski Partnership for Prevention. So thank you very much for having us. I thought we'd start this morning with an introduction to who is Prevention Works Vermont and what do we do. So Prevention Works Vermont is a network of community coalition leaders prevention consultants service providers and individuals from across the state. We collaborate with local substance misuse coalitions across the state as well as other community organizations that share a common goal of supporting healthy living for all Vermonters. Prevention Works Vermont partners help shape how substance misuse prevention is valued in our state. Our mission is to unify voices and be a guiding force on policy practice and attitudes that promote substance misuse prevention health and wellness in Vermont. And our vision is a strong sustainable and unified system to prevent substance misuse. Basically it's a long way of saying that we're a coalition of coalitions and we all work together and we have we're made up of leaders from across the state. So we are experts in the work that we do and we're here to help you. All right Cindy. So it made sense for us to start off with the kind of the definition of use substance abuse prevention and we're going to start off with what is primary prevention and it really focuses on delaying the onset of any drug use whether it's alcohol tobacco or marijuana which are the most commonly used substances among youth because we know that the teenage brain is still developing and that leads to a greater risk of developing addiction. 90 percent of those who develop a substance use disorder start using drugs before the age of 18. So our goal as families communities and the state really should be to postpone substance use as long as possible. Secondary prevention is also called early intervention and it's trying to detect who's at higher risk for substance use and early early initiation. The goal is to intervene before the the use continues and hopefully stop the use. Prevention efforts basically focus on creating an environment that protects adolescents from early substance use comprehensive strategies to reduce risk factors in the community. And those are things like social norms the environment and drug availability and it's they're counteracted with protective factors such as education support reduced to access and community engagement. So the process that we use in prevention is called the strategic prevention framework and it starts with an assessment. So we do a community assessment of what what's happening in our community and then figure out why it's happening so that when we implement prevention strategies we're addressing the root causes of what's happening. An example might be if we had really high tobacco use and we find out that youth are accessing tobacco at retail stores then the strategies would be addressing the retailer and and educating so that they weren't providing to minors. If we found out that the access was coming from the home we would do do a similar strategy but it would be focused on the home versus the retailer. So really important to do an assessment locally so that we're addressing the root causes locally. And then from there we go to capacity we want to build capacity we want to bring all sectors of the community together to work on prevention because it can't just be the school can't just be the family can't just be the community. It has to be a concerted comprehensive effort. And then we do planning and we plan for evidence based strategies that that address those root causes. We implement those strategies and then of course we evaluate and this is a constant circle. We're constantly evaluating reassessing rebuilding capacity. So as Dr. Valente talked about risk of harm we know that perceived risk of harm from marijuana among high school students has been decreasing in Vermont. This is trend data from 2011 and research shows that a perception of harm as it decreases use increases which is a concern. Next slide. And normalization of marijuana. What are the community norms around marijuana. It's led to over half of our high school students believing that it's wrong only half of our high school students believing that it's wrong for them to use marijuana. And as you can see that's been decreasing over time as well. Past 30 days of use of marijuana among our high school students has pretty much stayed static until the most recent data that we have which is the 2019 users behavior survey. And we have seen an increase. You know over trends for substance use in Vermont for the most part we've been seeing downward tech trends but in marijuana you know with alcohol tobacco etc. But with marijuana we've been seeing increases. In my own community for 20 years we've seen decreases in all substances. But on this past youth risk behavior survey we saw 100 percent increase in marijuana use from 16 percent to almost almost a third of our youth using marijuana. So when we talk about strategies we want to make sure that any prevention efforts are comprehensive and that means that we want to use the Vermont prevention model. We want to do all levels. We want to start with the individual. We want to with education. We want to go to relationships make sure that we're addressing the family because if if things are happening for the individual and they have good knowledge and attitudes but they're going to a family or a community or a school where things are different we're not going to make change. So it really needs to be all the way from the individual all the way up to policies and systems. So prevention strategies. Typically what what research shows is we have to do a number of comprehensive strategies and these are six of them. Education skill building limiting access community norms support and early screening physical design and policies. I'd like to do an analogy about the about COVID-19 about the prevention measures that we used across the country. So when we talk about education and skill building we were educated on the dangers of the disease. We learned techniques to prevent the spread. Education was based on science. We limited access. You know we limited access to others. We social distanced. We wore masks. We were limiting access to the virus. Community norms it really became normal for everyone to be wearing masks to be washing hands to be following the safety techniques that were recommended. Support and early screening we recognize what the symptoms of the disease were. We got tested and we were given support if it was positive testing. Physical design we found that there were six feet reminders everywhere. When stores opened there were there were one way pathways. We created a design that limited our access to the disease. And then of course policies certain businesses were closed fitness centers were closed. Businesses were closed people were required to wear masks in the store and it was limited. How many could gather. Now if we go into substance use prevention we use these similar prevention strategies. For instance education and skill building. We implement educate evidence based education on the dangers of substance use. The disease of addiction. We teach refute you feel refusal skills and healthy lifestyles. We offer we offer parenting programs. We work to limit access. We require we require retailers to be trained. We have compliance checks. We encourage adults to secure their drugs alcohol and marijuana in the home. We have social ordinances. In terms of community norms we strive for environment reduces youth exposure to alcohol tobacco and marijuana messages. We host substance free events for youth and families. Support and early screening. Parents and school staff recognize early signs of youths and we make referrals for support. In terms of physical design we limit density of outlets. We limit signage. We have smoke free parks. And then in terms of policies there's zoning ordinances. You know something may be not be allowed a thousand feet from schools or places that children gather like parks. This is a prime example has we've seen a prime example of this in Dr. Valenti's with policies for tobacco you know tobacco prevention and this is the same. So some here here is a little bit of additional Vermont data just to be aware of that 6 percent of our Vermont high school students report trying marijuana for the first time before age 13. 40 percent of our high school students report ever using marijuana and 62 of our Vermont high school students report that it's sort of easy or very easy for them to get marijuana. And this is all based on the 2019 YRBS which is the most recent data that we have access to. So I want to talk about funding because you can't put these prevention strategies into practice without funding. And funding in Vermont the majority of prevention funding has been underfunded and most of it has been federal and most of it has been competitive. You know number of prevention coalitions for tobacco for substance use has been less than it had in the past. We're a little concerned about the 30 percent of the excise tax that is listed in the law to go to substance misuse prevention because we have to ask how do we ensure that the funds go to substance misuse prevention as intended. Is there a dedicated fund not in the law there isn't. How do we ensure that the funds are allocated based on criteria as to what's evidence based prevention who's going to be making those decisions. Is there a designated agency or department with expertise in evidence based practices that will manage the money. An example of what happens when there is not a designated fund is Act 82. In July in July there was a law that this law states that a significant portion of any new revenue generated by taxation of substances at risk of misuse including cannabis tobacco tobacco substitutes alcohol and opiates be directed to fund substance misuse prevention. There was no designated fund or designated management organization or agency. Also in July Act 8 Act 28 increased the tax on e-cigarettes so those of us in the prevention community were expecting that we would see some prevention funding but that's not what happened. The e-cigarette tax revenue went to general health care instead of going directly to substance misuse. This has been a concern that both the governor the substance misuse prevention committee and prevention works has expressed. So let's talk about licensing education compliance and enforcement you know local prevention coalitions and prevention works have worked with the Department of Liquor and Law do control over a decade providing a unified voice and a guiding force on policy practice and attitudes that promote substance misuse prevention health and wellness in Vermont and this partnership has led to local coalitions hosting retailer trainings which then implemented prevention strategies into the trainings that these that retailers were required to participate in and also local coalitions have spent time recognizing local successful compliance checks and giving additional support to retailers that didn't pass the compliance checks. Our recommendations around licensing enforcement and education is that there be point of sale training for store owners and managers as well as store clerks that is in the law. Curiously it's the requirement for the licensee is for every three years but the requirement for the staff is every two years which we weren't really sure what the purpose of that was. We would like to see that there's a two-year requirement for training because things do change over time. We hope for full relicensing and retraining when a store changes ownership and frequent compliance checks just like we we have for tobacco and and sometimes for alcohol. But in order for this to be done there needs to be some resources put behind that. And we really believe that these enforcement efforts should be on the retailers and not on the youth. Next slide Jess. Is this my section I think or Cindy are you all are you all set. Yep you're on. So I have a pretty brief section but just focusing on one aspect of this community prevention that can have a huge impact on youth perception and access. And I have a quote there from ChangeLab Solutions which I think Andrea mentioned too it's a really great resource has tons of data to support the the evidence behind thinking of licensing and I know this board is going to be focused on the state and so we wanted to give you some tools that that can help with that aspect of that. I think you can go to the next slide just if you can. So these are tools that have been shown to increase health equity especially when it comes to other substances and I'm still looking for the article in my notes but in San Francisco there was a study that showed that having policies like this in place helped youth who may not come from you know a family that's very educated on substance use prevention or might not have access to adequate health care on a regular basis. These kinds of policies can really make sure that all youth no matter what background they come from are able to grow up as healthy as possible with their brains and their bodies. And so specifically we're hoping that this board will consider strongly limiting the total number of licenses allowed statewide and also the concentration of licenses because both of those have an impact on how youth perceive things are normal or for them and and you know ease of access as well. And so those were the two things and also to think about a half mile distance it's like the most commonly walked distance. I know you know where we work in Manuski it's a walking district so youth walk up and down Meane Street every day to go to school which is so great for their physical health but they are constantly bombarded with ads that you know as adults we know where this stuff is it's not really actually geared towards us but it really impacts them and gives them impressions about what's okay and you know I mean we're all familiar with the different types of ways that these things are sold. So places to keep in mind youth centers schools daycares playgrounds substance use treatment recovery centers there's a lot of connection between what triggers somebody who's in recovery and also a youth library's bus stops things like that. And that's all I have so thank you very much. You muted. Thank you. Sorry about that. My dog was barking and I muted myself by accident. All right so now we're going to move into advertising. So advertising for adult youth substances is often designed to target youth in some of the traditional tricks of the trade and to recruit future users which are youth or things like bright colors hanging advertising low to the ground and discounts or buy one get one free offers or two for a dollar or two for whatever price point. Those are all things that are designed to be exciting and engaging to the youth eye and to make products more attractive to the youth budget. So without signage policies in place you wind up with stores like this one. This is a store in Colchester. This is just one of their windows in the door. This particular retailer had more than 17 ads promoting adult youth substances visible from the outside. This picture was taken in mid-February of this year. So this is current and if you look closely you can see the $7.58 here that says why pay more with a picture of two packs of cigarettes is the lower half of the door which is or the window which is the eye level of children. So adults are not being targeted by this ad. That's something where children are going to see it much more so than adults and then here again below the midway point of the door you have this ad for a jewel saying that the starting kit is on sale for $29.99. So as you can see from this example to both tobacco and alcohol are really good at marketing toward children even though that's not the target audience according to the age for selling the substances. But these companies have always been advocating for targeting young populations. So our hope is that we consider how advertising policy impacts youth use. Flavors is something that we're we've all been talking about for years now with tobacco less so with alcohol but it's still something that we need to be aware of that these companies use flavors to target youth and make things that are appealing. This top row of the images here are pictures of e-juice that is specifically designed to look like products that children find appealing. So we have Drippin' Whip that's supposed to look like ready whip whipped cream. We have Vanilla which is supposed to be vanilla wafers and a Candy King batch is designed to look like sour patch kids. As much as big tobacco likes to talk about these products being for adults these are very clearly targeted to appeal to teenagers and youth users and not so much to the adult market. The bottom two pictures are examples of flavored alcohol that's designed to appeal to youth and young adults. We have a glazed doughnut and rainbow sherbert vodka. Other flavors that youth are particularly interested in are mint or menthol mango chocolate other kinds of candy gummy bears birthday cake berries other fruits ice cream cereals. So the recommendation here is that we don't allow any flavored additives because these generally speaking are specifically to attract youth users and not adults. So this image here is an example of how Canada structures their packaging and this is our recommendation is the gold standard for the best way to structure packaging in a way that is not appealing to youth. So we know that the law says that cannabis products are required to be sold in child-proof packaging and that we're not supposed to be targeting people under 21 with packaging advertising or what the products themselves are. But the law doesn't really specify what that means. And so these are some of the things that we would like for you to consider. So you see here this package is solid black. There are some that are solid white where the number one is there's a graphic warning label in the shape of a stop sign so even young children can recognize that this is a product that is not for them and something that is dangerous and something that they should stop and put down if they were to come across it. Where you see the number five over here this is the target for the size of the logo so smaller than the graphic warning. And then you see here the brand name in plain font with no bright colors nothing to make it appealing. There's no room here for cartoons or other things that might appeal to children. Here we have the ingredients list. So this says what the THC percentage is. It lets you know what the appropriate dosage is. We're recommending that all packages be single dose and not multiple doses and that's particularly something that comes up in talking about edibles. Frequently things like gummy bears or brownies or chocolates are packaged as a chocolate bar or a full brownie or a bag of gummy bears with the appropriate serving size might be say one or two gummy bears or an eighth of a brownie or a chocolate bar which makes it easy for accidental overdose to not understand what the appropriate dosage is here. And then here we have in larger text in the brand name in number four the warning label. So explaining what the possible effects of THC are and making sure that people know that this is not a product designed for children. We'd also like to talk about advertising policy. So you see here I've listed on the slide a phrase called content neutral advertising. So basically this is the best practice to make sure that policies can't be challenged later. So content neutral advertising policy basically states that regardless of what the contents of the signs or the advertising are that you would set a percentage of the exterior of your store that couldn't be filled with advertisements or signs and that no more than that percentage would be allowed to hang up. So signs would include in some cases the name of the store if you have an open or closed sign maybe you hang up the hours of the store in addition to things like cannabis tobacco alcohol Coca Cola advertisements etc. So the idea there is that you would make sure that you reduce the amount of exposure to advertising so that particularly if children are driving past the store or walking past that they're not seeing as much this is both important for reducing the impact of advertising on youth as well as increasing safety of people coming in and out of the store. So if you remember the picture I just showed you of the store in Colchester there were so many things in the window in the door that it was actually very difficult to even see if someone was coming at you at the door. So it's not uncommon to bump into someone because you can't see them when you're coming in and out of the store because cannabis is a product that is federally illegal. You can make specific requests or laws around what you allow for advertising for cannabis without worrying about free speech but the gold standard for how to best approach that is to go at it from a content neutral advertising perspective instead of just we're not going to allow this particular substance to have advertising but that is an option that's available to you because of its federal illegal status. We're also advocating for no discounts or price promotions again because those are things that reduce the price and make it easier for youth to be able to afford products and then to be able to engage in them. We also wanted to talk about potency. So potency has a really important impact on mental health. Just 15 percent THC in the flower triples the risk of psychosis in cannabis users and that increases by five times with daily use. So we recognize that the law says that potency of up to 60 percent THC is allowed and concentrates. We would like to encourage you to set some rules to reduce that because that high of a percentage of THC can have really strong negative impacts on the brains of the people who are using especially in that young adult age bracket. So the anytime you start using substances when your brain is still developing. So under the age of 25 you increase risk of psychosis and you increase risk of developing a substance use disorder. So even in that legal use rate between 21 and 25 you're still at risk of damaging your brain by substance use. So lowering potency will lower the permanent risk of brain damage for people in that young adult window. And then just some additional information for you. The pediatric cannabis exposure rates increased by five times in Colorado between 2009 and 2015. So comparing the rates prior to legalization and after in Colorado and then hospitalizations where kids had to be admitted triple or sorry doubled after legalization. So those are some things that are concerning. Most of the children who were impacted by accidental exposure were children under three. So making sure that potency levels are lower and that your packaging things individually reduces the risk of accidental poisoning for children who might get their hands on things that their parents might have purchased. So California and Colorado both exploring reducing their allowed potency in response to the increased risk and the increased hospitalization rates that they've seen in children. So our recommendations include reducing the allowed maximum percent THC below the current law which says 60 percent. Ten milligrams of THC is considered a standard single serving. But we're recommending that we also have five as the considered starting low dose for first time use. So you can build up some tolerance to substances which means that those who've never used them before or might be in that 21 to 25 age bracket if they're able to purchase something that has high potency and they've never used before they're much more likely to have negative impacts as a result of their use. So if we can reduce and have smaller starting doses that can make it safer. And again making sure that we package in single servings eliminates accidental over serving and reduces the risk of poisoning in children. All right Cindy it's back to you. So we've pretty much already covered this piece so why don't you go forward. So in summary now that cannabis retail sales are coming in Vermont we hope that as regulations are determined that the impact of our youth and what can be done to protect them will always be considered. We understand that some of these recommendations are not under the purview of the board but we hope that they'll be included in your recommendations to the legislature. So we advocate for a dedicated fund to ensure that the funds go to substance use. And not let history repeat itself with the funds going elsewhere. We would advocate for an agency such as the Vermont Department of Health to be designated to disperse the prevention funds to ensure that it's allocated to evidence based prevention practices. We would advocate that cannabis facilities and outlets do be distanced from anywhere that youth gather and that the density of outlets be limited. That advertising and signage does not promote marijuana use messages to our young people. That potency limits be considered. And that preventing access of cannabis products to youth through enforcement be focused on retailer training education and compliance through an experience agency such as the Department of Liquor and Lottery. So we thank you and at this time if you have any questions we'd love to take those. Great thank you so much for that presentation. Are there any questions for Jessica in your case. I have a question and I think you've touched on this a little bit and I know that I spoke with you some of you about this. But I think it's really important for the public to understand. Do all towns and schools in Vermont have access to the same level of prevention programming. They do not. They do not. Currently in Vermont there are huge gaps because the funding is competitive and the funding is limited. So you do have areas in this in the state that really do not have any prevention funding. So that you know that and the federal fund a number of us have federal funding but that's competitive as well. So when you look I wish we had brought the state map because you can really see that there's certain counties like Essex County that's really has a gap in prevention efforts. We down in the in the Wyndham County we've been really fortunate that we've had prevention funding and our coalition for 20 years have had sustained funding and the result has been sustained decreases in substance use. But in other areas of the state that's not the case. Thank you. And then you touched on educating parents about locking up drugs and alcohol in the home. What does that look like. Right now in our area we're doing a campaign called parenting in the pandemic because we've been really worried about more youth home unsupervised. And it's about having the conversation with your youth about expectations and then securing any substances locking them up alcohol marijuana prescription drugs and to and to be treating marijuana and alcohol the same as you do your prescription drugs because we know that they should be out of reach. So really having the discussion with your with your youth about why you're locking them up and then making sure that they're secure in the home. And then another example of that is disposing of unused unused or expired prescription drugs so that they're not in the home and there's been a number of statewide and local campaigns around disposing properly of your unused meds. So I wonder about that related to cannabis. So there might be a parent who purchases cannabis for the first time or the first time in a long time from a retail store uses some of it and doesn't care for it and you know some guidance on how to dispose of that properly. What would that look like. Someone else want to take that. Yeah we've done a lot of that in Chittenden County where we've educated pharmacists around opiate. So I imagine something similar maybe I don't want to speak for the police departments but I know they'll take opiates back and now they're also taking vapes. So maybe they would also take unused cannabis products as well which I'm I want to guess that I think people throw those in there sometimes anyway so I think that would probably be a good good partnership. And I guess I would also add just making sure that all parents you know see the resources that are available. I think I mentioned this at one point but there's a lot of parents I've run into that have never heard a parent up and it's a I think it's a really great place to go ask your questions and get some information. But they just you know the marketing budget is not the same as it is for Coca Cola for example. So it'd be great to find ways to get that more more awareness of that so people know where to go for questions. Cindy Jessica Kate thank you so much for being here. I had a question you had I think given us kind of a recommendation that every time ownership of a license changes hands re-licensing and retraining of you know what to do what to say how to educate folks. I would imagine you're referencing at a retail level. And I know you mentioned your six points on prevention strategies but I'm curious from a training perspective and maybe it kind of even goes into how to dispose like Julie just mentioned but what types of training or education can can retailers at that level provide folks that may have youth in their home on what to do you know or you know I know obviously you've got to check an idea at the door. That kind of thing if a youth is is trying to purchase illegally but what kind of training exercises in your experience would be would be helpful from an education standpoint that the board can really dig into. For the retailers. Yeah I mean I think that that's the way I understood one of your recommendations from the like holder perspective and you know I think the board is really interested in education to the state more broadly but I think it should be similar to the education that the Department of Liquor and Lottery do for alcohol and tobacco. So they start off with what is the law so that the retailers are very clear on what the law is and what the consequences of providing to a minor are. The other piece is how to properly do ID checks and typically they pass around licenses and so they're teaching the retailers specifically how to identify a false ID. They talk about techniques to not provide to a minor and what are typical things that a minor might do when they come into a retailer. For instance they might park in the back. They walk around the store they wander around you know being knowledgeable also how to refuse a sale. All the techniques of how to properly refuse a sale in keeping yourself safe. An example is you don't leave the product on the counter you're immediately put under the counter when you say that you're going to refuse the sales. All sorts of components in that training I think would be very similar to a training for marijuana retailer. And then as I understand your question it's also about like what to help the retailers help the parents who might be going in. So I think the Department of Liquor and Lottery they've had some educational materials that we've put out before. I would imagine it could be training them to remind parents you know keep this out of reach of youth in your home. Make sure you lock it up after every time you use it. And you know our organization we just purchased some lockable medicine bags to give out to people as part of that effort as well. So that could be potentially something that could be scaled up for coalitions across the state could provide that or something like that. Thank you and in the three of your experience those techniques that Liquor and Lottery provides have been relatively successful. Absolutely and the in-person are the most effective. You know they found through research over the years that those that participate in an in-person training have a higher rate of successful compliance. I think now since the pandemic they've really up their game on virtual trainings and there hasn't been research yet but that might be a possibility as well. I think the really beneficial piece about the online training is many of us are present during those trainings and so we're introducing ourselves. We're introducing resources and we're introducing preventing components and we're also recognizing those those retailers that have successful compliances. Yeah and one of the other things that I'm thinking about and in one of in the purview of 164 one of the things we need to decide as a board is delivery services and how does this type of issue you know somebody showing up with somebody's doorstep and what do they need to do just get an ID so on and so forth and so that's something that the board is also considering and thinking about itself. Putting that bug in your ear if you have any more thoughts you know well we can engage further down the road and we kind of get a little bit more under our feet on how we feel about that kind of process. I've got a question a comment first which is I hear your concerns around a dedicated fund for the Department of Health and so thank you for flagging that. I think that was kind of the I mean I think that was the intention of the law but it didn't they didn't go all the way so is 10 is 10 million dollars which is kind of the cap of the of the money that's dedicated to prevention is that enough to kind of scale up your prevention initiatives and fill those geographic gaps that exist around the state and maybe haven't thought about how to spend 10 million dollars quite yet but I'm just curious if that seems like roughly the the right amount. That's a good question. Think about it you don't have to have an answer for us today and I know that you know this is an ongoing conversation and it's you know nothing you say here today would prevent you know prevention works or others from coming back to the table at a later date. Right you know ideally I would see that we would have a community coalition in every area of the state and when I think of area if I thought of Supervisory Union this the area that's covered for instance I'm the Windham Southwest Supervisory Union so I cover five towns if we could have a coalition in every one of those areas with a minimum of a hundred thousand dollars to at least get started I think that would be a really great start and you know I don't I'm not aware of how many Supervisor Unions are I'd have to do the math on that so to me maybe 10 million is not enough but I think what's really important is that we start looking at the gaps around the state and make sure that we have prevention strategies covering every area. Yeah I know how I know how stressful having to continuously go after competitive grants and data. Yeah and that's that's a major issue it's you know coalitions come and coalitions go because the funding is not sustainable and you know our hope is that this funding we maybe may lend to more sustainable efforts and the and the other piece is that generally the grants are two to three years so when you're hitting that three years and you're not you're in the competitive process again you've got staff that they don't know if they're gonna have a job the next year and so you're losing dedicated staff as well because the funding is not sustained. Did I hear that there was a map that kind of identifies services that are available and you know in particular the gaps in those services? Yeah through the substance misuse prevention committee a map was created and I can make sure that we get that to you. Okay great thank you. Any other questions or Do you have knowledge of education programs on college campuses? So there are some college campuses that have more robust substance use prevention programs than others so like UVM for example has a whole team as part of their I believe it's called the living well department that focuses on prevention efforts and and other health programs for students but depending on the size of the university what is available to the student body is drastically different from school to school. And while there are places on college campuses for students to have access to support that isn't as easy for those who don't choose to go on to college. So we do have data that shows that those who don't choose to go to school are more likely to use substances at higher rates than those who are in college partially because we don't have access to them in the same way to provide those prevention programs. Thank you. Yeah that kind of gets back to one of the questions I asked Dr. Valente was how does the board help those 18 to 21 year olds that might not have a sick fall through the cracks from educational perspective on these issues. Thank you all really appreciate it. Thank you. Thank you so much. Thank you. Thank you. So if you would like to make a public comment please raise your virtual hand and we'll go in the order that they come up and then we'll move to people that are potentially joined by the phone. I don't know if I see any and then if you don't have public comment now. Okay. Then so we'll start with what is it? Cannibal farms. Unmute yourself and turn on your mic or turn on your video if you would like. I'll leave the video off. Great. Great we'll feel free to question about how the state plans to do the funding and remain competitive for the farmers. I mean I know that the funding for prevention is a key, key part but with states like California having to bail their own cannabis industry out because the taxes are so high that the underground is back to being the better price than the legal farm. I was just wondering if you could elaborate at all on that. I'm not sure that we're in a position to talk about funding. Of course a lot of those decisions actually get made in the in the legislative branch. The cannabis board kind of takes our cues and develops regulations. So if there are funding opportunities like the social development equity fund that those are those are legislatively decided. So next on our list is it Mariah Flynn. Sanderson. Sanderson. Feel free to unmute yourself and turn on your video. Hey thanks for giving me a chance to speak. I just wanted to kind of comment and respond to a couple of things that I heard from both Andrea and the Prevention Works team. So I also work in the prevention field. I spoke with Kyle yesterday and I wanted to kind of offer additional support for the idea to think about how policy and systems in particular can be used to help with prevention efforts not just funding towards entities that are doing providing supports for individuals and relationships in the community but also thinking about what's our role as a state in what the policies need to look like to support prevention. So for me I think some of what Andrea was kind of quickly going through was that pieces around like taxes actually have one of the biggest impacts right in reducing youth youth youth and and then at a community level looking at that density of retailers and and the and the how alcohol or how cannabis will be promoted in communities and what kids are exposed to for me is like some of the most important work that we could do around this issue to help protect youth. And as someone who's a strong social justice advocate and really cares a lot about what we're doing in that field in Vermont as well I think it really I work in the Burlington community so I think you can see the impact of density and advertising in a way that you in that community in a way that you sometimes can't in some of the more rural areas of Vermont on our BIPOC community members and our lower income community members because there is a density of retailers and advertising in communities where where those two populations are living in Burlington. So in thinking about how to be supportive and in a state who's moving in the direction of acknowledging social justice and doing more work in that area. I think this has a piece of that. This is really important to that work. And I've heard a lot the conversation being around how to ensure that BIPOC community members are part of the business of cannabis but I want I'm hoping that there's more discussion and more focus on how to ensure that they're not targeted in the way that alcohol and tobacco have targeted those communities for decades with this product and that we've we've really designed a community that doesn't do that again because I think I was mentioning to Kyle yesterday that we have an opportunity to do things differently this time and hopefully we take that opportunity. Thank you Mariah. Thank you. Next is Graham. Hey folks. This is Graham Yuenengstrupenach policy director at Rural Vermont. Appreciate seeing everyone's testimony here today. I've also worked with youth on and off for 20 years in different parts of Vermont and it's great to hear from folks who are still doing that work more than I am. So I specifically just wanted to comment on one thing I heard. The first guest from UVN spoke to labels specifically like organic, natural, etc. And I just wanted to speak to the comment that she made. She said that labels like that may affect people's perception that the product is less harmful and link that perception to risk to youth. And I think the fundamental reminder here is that we're talking about adult marketplace where youth are ideally not able to purchase products and that these labels like organic, like local, etc. They're labels which speak to specific management practices which speak to clear standards which do positively affect the health outcomes of the individual and the environment in which those plants were grown. They're clearly defined for people how plants and products are grown and manufactured. The labeling does not lead to, as she said, false perceptions. In fact, it clarifies any misperceptions by specifically referring to a recognized standard. And the point of labeling, like local or organic, and the point of prevention in my experience working with youth is not to create a judgment or perception in the subject such as not to create the idea that the label is right or wrong or that the use is right or wrong. But it's to honestly and transparently communicate and educate about the product based on on clear standards and clear evidence. So that was the primary point I wanted to make. I think the comment about limiting total number of licenses. Again, we know that we've in general encouraged from the Vermont Canvas Equity Coalition. We've encouraged limiting the scale of licenses as opposed to the number of licenses provide equitable more equitable access to the marketplace. And I think a lot of what we about alcohol and tobacco, which I don't think should be equated with cannabis as they have been. But a lot of the concerns that have emerged in those industries are because of the industries and how they're regulated. And what we've encouraged here in Vermont, the Canvas Equity Coalition, is to really make this a craft locally based industry where we're a large industry and corporate actors can't come in and create a lot of the problematic impacts we've been seeing. But otherwise, I think that we certainly agree with a lot of what was stated here today in different ways. Thank you all. Thanks for having me. Okay, next on the list is Gido Bern. Gido, if you want to meet yourself. Hey there, guys. So this has been really tough to listen to. I think comparing cannabis to tobacco is it just drives me nuts. Tobacco is just unequivocally awful in almost every way. And yet, cannabis is in many cases absolutely good for you. And when people try to tie the two together, it's just it never results in anything good. And that's how we end up with this awful vape tax that we got. They're trying to, the legislature's trying to address the jewel smoking in high schools, which no doubt is a terrible, awful problem. But then they use they use language that's so broad. It's like killing a mosquito with a sledgehammer. And anything that uses the word vape is not considered like tobacco. It's just all wrong and misguided. People using a pax to vape cannabis flower just can't be compared to tobacco in any way whatsoever. That's all. Thank you. Thanks, Tito. Thank you, Tito. Next is Melanie Sheehan. Hi. Thank you all for your time. I just wanted to thank my peers in prevention. I also work in the Windsor area. I work at Madison Kutney Hospital in Windsor and the Madison Kutney Prevention Partnership. I just wanted to and also thank all of you, the cannabis control board for your thoughtful questions and considering these issues. I'm also the vice chair of the substance use prevention oversight and advisory council. I'm on that body. And I was just reflecting on some of the questions that you've asked around strategic visioning, gap areas, funding, best practice strategies, and just on behalf of the council, I just wanted to say that we look forward to collaborating with you as a board. I know that our chair will be joining the advisory group when that gets pulled together. But I just wanted to say that there are great collaboration opportunities and I look forward to that. So thank you. Thank you. And thank you for your work with the substance use prevention council. Yeah. Thank you, Melanie. Looking forward to it as well. Next is Allison Link. Hi there. I don't know if can you can see and hear me. Hi, Allison Link. I live in Morrisville and I also am part of the prevention community work for Healthy Lemoyle Valley. And so I second what Melanie was saying about our colleagues and about the board and the thoughtfulness of questions. My questions relate to our local municipalities and towns and how to encourage and recommend to the board to consider the local towns and the influence of your decisions and recommendations on the local towns and municipalities, especially those who don't have zoning who without zoning will have really no ability to their CCC will have no ability to really make any additional changes or or create have more of their own say to the level that folks with zoning will be able to have. And so to consider along the way, I know I don't think any of the presentations they talked specifically about the local towns and municipalities, but our coalitions we work directly hand in hand with those folks we're trying to get them up to date information as best as possible so that they can make educated decisions about what they want, how they vision what their vision is for their town. So just to recognize the impact of your decisions on local towns and to especially those who don't have zoning and may have you know other codes involved. Thank you very much for that. Thank you. Next I see Ann Gilbert. Yes. Hello. I'm coming from Montpelier, Vermont. I'm the director of Central Vermont New Directions Coalition and we cover all of Washington County. And you know like Cindy said before there used to be many coalitions. There were six serving this area and now we're down to one but working closely with Central Vermont Medical Center and a team of other providers who are really seeing the crossover of the danger of all the substances. So it's not just the opioids alcohol is an issue and I just want to reiterate Dr. Volante's findings of you know youth experimenting and then moving on to other substances as well and how important it is to continue this work in the community education and for funding for all of the schools and thinking about the packaging. You know when vaping first came out and we polled kids many many kids and parents did not know that there was nicotine or what those substances were in those products and so education and the packaging are just going to be crucial and I appreciate all the work that you're doing and that everyone in the prevention community has had a chance to express some great knowledge today. Thanks. Thank you. So are there any others that joined via the link that would like to provide comments and if you do just please raise your virtual hands. Okay. We have one person it looks like who's joined by phone if you'd like to provide public comment now would be the opportunity. Okay. Well we're going to take a break we'll be back at one o'clock I got to thank all of our witnesses thus far. It's been a hugely impactful day and we have a few other great witnesses for the afternoon but for now we're going to be back at one o'clock Kyle if you could pause the recording and put up our away message. You got it. One second. Okay. Sorry about the slight delay it's one oh four we're back from our lunch break we're here with our next witness Holly Morehouse from Vermont after school the after school program did get a a little bit of money from enact 164 and so we'd love to hear just your thoughts and how we can you know effectively and safely implement an adult adult use program in Vermont. That's great thank you so much thanks for being here thank you for paying attention to our young people and and what all these changes mean it was also great to hear the other folks present this morning and I hope that what I can focus on will add only add to to what they're what they were speaking to I'm going to share the slides with you all there they are great awesome so some quick background Vermont after school is a statewide nonprofit we've been around since 2009 we are really focused on ensuring that all of Vermont's children youth and young adults have opportunities to be active engaged connected and heard we really feel like those are the keys to well-being and you know lifelong success right if you're engaged in things they have opportunities to be active connected all around the relationships and heard is the whole youth voice piece where we choose to focus our time is really working with youth serving organizations after school summer programs teen centers that are supporting children and youth in Vermont outside the school day and over the summer one of the reasons that we want to focus on that area is because of the amount of time that young people are spending in this space this graphic really talks about those spaces we call it the third space for youth that's the space outside of home and school and recognizing that what happens in the home of course is critical to growth and development what happens in the school and formal education systems as well but really what is special about that third space where they are playing sports hiking mountains I mean you know doing scouts robotics you know first work opportunities hanging out with friends and how critical that is to the development there have been studies that have shown that up to 80 percent of a teenager's time is in that third space so it's not a small amount of space when you take of their waking hours when you take an account the weekends the summers the afternoons that they get out early on an early release days and the evenings and so forth so I think part of our message is to make sure that any of our approaches around prevention or any issue that we critically care about for children and youth that we don't only sort of do this dual thing of let's only look at home and school thinking those are the only two places where young people are but really pay attention to this third space as well some of the data on why after school as you said there is an appropriation with some of the tax revenue dollars to increase access to after school and summer learning so I wanted to walk through just some of the data behind that when you look at the hours that teenagers young adolescents are most likely to age and risky behaviors be victims of crime commit crime being car accidents the studies show that it is really the hours of three to six three to seven in some cases it's not 10 p.m. at night so some of our assumptions about where teenagers are getting in trouble is really that time when school is out but family members are still at work and they don't have a place to be there are also studies that show you know these distinct differences in risky behaviors drug use delinquency on whether or not a young person is involved in constructive and supervised activities it does not have to be all school based it doesn't have to be tutoring in science although those are great too but it's being engaged with other young people with a caring adults in a structured place another study cited in the other handout that I sent in has all the citations for these the teens who don't participate in the structure activities are nearly three times more likely to skip classes experiment with drugs engage in sexual activity than teens who do um Paul do you want to try and just change it's just a little bit more like a conversation you know it's silly is this oh shoot I'm sorry I just like I want to do it to be able to see you oh I know I mean I can talk to that camera but then I feel like I'm going back to you we're still there you can't see Kyle I don't think that's fine okay it's all right I'll try to like do this thing this is our first time in a setting like this yeah I know mine too so it's hard to know like where to focus I think the other side of the actual problems not just the idea that okay if they're in a program they're probably not using while they're sitting in that program let's hope right so it's not just that space but it's also the protective factors that get built it's about that sense of self the sense of identity I'm not lonely I'm not bored I'm not alone I'm actually engaged in band or sports or have my own music group or drama or whatever it is there's all studies that show self control sense of self self agency all increase with regular participation we've also seen over a month we've had a major initiative to focus on social emotional learning and trauma-informed practice and are seeing you know where you have staff that are skilled and able to help you through that hopefully we can mitigate some of that those generational issues when you experience trauma in their own life looking at the Vermont Youth Gris survey data as well 2017 and 2019 questions added about for high schoolers how many hours per week are you participating when you look at that participation 10 hours or more across the board all kinds of rescue behaviors you see go down I mean it's from bullying to driving without a seat belt to cannabis marijuana use alcohol and so forth you also see in that same data source that when you look at the sense of belonging for young people who participate 10 hours or more in an after school program about 70% of them feel like they really matter in their community they really belong compared to those who are not participating in at all it drops down to 47% so significant difference there also two out of three Vermont parents this is from a different study agree that after school programs make it less likely that youth will engage in risky behaviors that's a 2020 study if we have some questions should we wait till the end would you prefer that it's fine either way it really is for us let me go a little bit further yeah do your thing and then but I have time that I hope so that they'll be like half of this and then like let's really dig in I am the other thing I wanted to mention is that through Vermont after school we haven't only been looking at what works in Vermont or across the nation we've been looking at international models as well many of us in the prevention world have seen you know the studies from Iceland and the dramatic results that they've had Vermont and Vermont after school the five communities we're working with were the first in North America to actually sign on with Iceland and Planet Youth to pilot some of that here we have expanded on that model and what we're calling the Vermont Youth Project to also draw from Finland there's another example where they have you know some of the best test scores and education outcomes also one of the shorter school days so when you think about third space in Finland it's even longer than it is here so some of the questions that you know we had was well what are they doing with that third space well they have a whole field of field work with trained professionals you know bachelors and masters of phd in young people and how to support them all the way through and they have youth centers in every neighborhood where you're really looking at those hours of 12 noon to 9 p.m. having artisans come in and theater projects and the whole idea is that every young person in Finland will have a hobby or a passion and it's a way to socially connect it's a way to grow your self identity in Iceland the approach really has been I'm Cindy talked about earlier with that ecological model where you look at the whole society and they they have started out focusing largely on sports center so you're a young person in Iceland you go to school to a one or two a van or a bus picks you up and it takes you to a sports center and you spend two or three hours like engaged in some activity that you really do so you're a physical activity as a young person you've had the learning your parents pick you up at the end of the day like you you change that whole society around young people for the youth project I think that's one of the biggest messages is not just focusing on the young person making a good decision but on changing our society around them so as a board in the recommendations you're making I'm hoping that the more you can think about the society that we're creating around our young people and how that connects to prevention where it's coming from really is to not look at just in the green where oftentimes we think about substance juice like why are they using right well you know they're not engaged in school they're bored whatever but really going further back and saying okay why are they bored why are they right so in Vermont often is transportation in our rural communities right they go home on the bus and then they can't get anywhere else you know so what can we do as a society that instead of says you know oh you know you're home alone bored you shouldn't be that you know you should be doing that you should be more engaged but we haven't supported you in figuring out like how to get there and make that possible the other thing that I think is important in this model and that we draw from you know some of those other national examples international examples is really really recognizing that this time in a human being's life adolescence middle school high school young adulthood is so critical to the brain development and I know that was mentioned earlier this morning as well you know that cortex frontal lobe that reasoning that making good decisions and always consistently thinking through the consequences it's not fully developed so to focus prevention efforts on make good decisions really understand the consequences is really going against human development and science when you look at the Iceland model they just stopped doing that they're like they don't when they talk they don't like talk about prevention with their youth they just change society with this idea that every young person in Iceland has the right to grow up substance free so what does that mean it means changing societal norms nobody's using if nobody's using then you're not going out with your friends and drinking or using because nobody else is if all the parents sort of have that common messaging around whether it's a curfew or spending time with your family then that's your norm and even if you're not in the if you're a family that's not as engaged what they have found is if all your friends are that rubs off so as a societal investment there's there's a big thing for your buck they have found over the last 20 years they'll say they have the worst teenagers in Europe as far as use rates they have about 20 years ago they had 20 or so facilities that were dedicated just towards adolescent drug and alcohol misuse over that period of time they've been able to close all but two so think about cost savings when you change the society it no longer becomes a thing that that you're doing as a young person there and the cost use the cost savings there the other thing I want to point out in the connection to after school in particular our third space programs at this period of development and why I think it's so great that some of this revenue can go to support programs for youth is that in this period of time adolescent brains are actually rewiring and we often talk about brain development for birth to five which is the most critical rate a lot's happening adolescence is the second one right they're parsing off things they're actually reshaping their brain so we have to think as a society what environments do we want these young people in as they're reshaping their brains do we want them doing robotics right and club sports or you know hanging out with supportive adults do we want them doing service projects and what do we want in that 80% of their waking hours that they're spending outside a home in school and how do we how's that going to shape their brains so there's a piece of this for me that's around what environments are they in how important those after school and third space programs are to help shape those brains beyond the school day beyond the home also how to and Cindy said this this morning to lay the onset of youth of youths protect those adolescent brains if we can get that message to parents and families business owners decision makers protect like really see this period in time as unique and so so important and instead of setting up policies that go against what their brains are doing risk taking you know sensation peer pressure instead of trying to go against their brains treasure their brains protect their brains and set up our prevention measures to really support that time in life until they become 2526 and then then it's a different scenario the Vermont youth project there are five communities that are participating in this as far as the after school programs and so for that is statewide we are working with promises you know all across the state Governor Scott major initiative about universal access that is tying directly to this prevention work the youth the Vermont youth project communities are trying to go step deeper and really take everything we're talking about here and think about how do we change our communities in their entirety so they've signed on to a five year project when the second year the pilot we do use the Iceland survey they do have these community wide strategy building teams we've added in youth councils and youth voice which is really coming from the Finland side they have data it's different from the YRBS in a couple of ways I would say I'm not going to go deep into the data here and much of it aligns with what you've already heard I will say the thing that's different about this data is that it's it's real time so they take the survey they survey all seven through 12th graders in October and we have the results back and the analysis back by the end of December so it is those kids in that community at that moment in time the response rate in our first year pre-COVID was 82 percent last year with COVID and virtual learning was 65 percent we're hoping to see that go back over 80 the other thing that's different about this data is that it doesn't just get it the use rate so it'll have who's using marijuana when do they start it gets at it has questions about behind that where where are you using when and the why you know what is it what is what is your impression of peers who smoke right or use some of the findings that we have found and that especially when we compare ourselves to Iceland and some of the other nations that are are doing this work our cannabis use and alcohol use in Vermont is high it's just high you know that parent and family engagement is strong in in Vermont like we're spending time with our youth which is different than Iceland and some other places but what we're not doing is we're not partnering together as parents you're setting your own roles in your house I'm setting my own and then when my young person wants to go do something they're like well everybody else is doing it right whereas if we spent more time on this sort of co-collaboration we could change sort of that that norm we are also seeing that there's space activities the after school programs that unorganized free time is prevalent in many of our communities in Vermont these are examples of some of the data so that you have it like I said it lines up with other data that has been shared here it does get at such as this 15% of 11th and 12th grade students report smoking marijuana increases peer respect so it has these elements that sort of try to get at the why the other data that is especially in the 2020 are as there's some mental health and COVID data which I think is also something really important to look at so you know over half increased loneliness and bored there's high rates of young people saying things have gotten to the point that they can't even handle them sleeplessness like 30% of our young people experienced sleeplessness in the last week like all those signs that we need to pay attention to in the prevention world the biggest point I think I want to make is that when it comes to Vermont and this is I really appreciate what governor is doing right now what you have access to in that third space it's kind of a luck withdrawal right it's where you live what community you're in in some communities they've got programming five days a week they've got all summer they've got all ages and next community over there's nothing the other thing that plays in is income level and what you can afford to do if you have money in Vermont you can go to a bias camp one week and basketball camp the next and then you go to La Crosse and then you're in you know you're at the Flynn Center and you're doing a play like you can develop that brain that we're talking about and have all these experiences if you don't have those resources you're not doing any of those things so those brains are developing very differently and that's going to implement implications going forward the most recent study was from December 2020 it was released there's more than 26,000 children and youth in Vermont that would be in a program this afternoon or during this day in the summer if more were available the biggest barriers are accessibility they can't get to them availability they don't exist in their community and affordability and that was based on a parent survey so the money in that bill to expand access is so critically important if we're going to have this this brain development and brain protection some of the things that have been happening and prior to this the opioid coordination council and the marijuana commission both named increasing after schools in their top recommendations Governor Scott stated the state address before COVID laid out universal access as a goal last year the legislature passed bill to create the task force that report is now out and included the funding and the marijuana commercialization bill and the last couple of months there's been this huge push on summer and summer programming for all ages not just young all ages as part of Vermont's recovery effort as far as the money goes the communities are ready you know we had the tobacco settlement money we had $600,000 we got over five million $5.5 million in requests from communities all of like they are ready for the summer matters grants we started with $1.5 million we opened those grants up we got something like $7.3 million in requests in like a 10 day turnaround like people are ready we're ready as a state from an after school we know how to support systems and structures and professional development we know what the answers are already we we just need the funding right to flow we need the the workforce to go with that I think I'm going to stop here for questions the lessons learned and recommendations we can move to but I want to make sure we hit on those questions thank you any questions go ahead I just want to ask about the Iceland and Finland information that you talked about because they've seen a reduction in youth use but adults I would assume are still using alcohol in Iceland I don't believe it's a dry country so where did they find that nexus of this is for adults and not for youth can you talk more about how they communicate how they how did they change society of my understanding right it's going back to that brain piece and delay the onset so what where you know when you have that mixed messaging that it's safe to use or that it's responsible use is okay right you got to have that piece of but not for these brains not for this age because the brains are still developing and we don't want to muck with that development so they'll they'll they'll talk about delay the onset and they'll measure and they're trying to continually push back when they have their first drink when they first try a substance right and push that back because the other studies have shown that the more you push that back the less likely someone is to use or to become addictive right because if you're using one of that brain is developing in the prefrontal rate you're going to be more prone towards addiction that you're changing your brain chemistry and structure right I'm not a neuroscience but that you know that's you know scientists but so so I think it's that messaging and it's so if you think about like I've heard them say young people and I son have the right to grow up substance free so you know let them get the strongest best healthiest brain and then make their choices from there right there was one of the speakers was talking about this image of you know in the U.S. we have this we have this mythology we talk about you know the youth who makes the best you know they're against all adversity they have the worst conditions in this and that and the other and they're facing all this and they still succeed right so we praise and we lift up the example of the young person who swims upstream and is still successful what Iceland and Finland are trying to do as you change the direction of the stream right so wherever you jump in there's a you're right like and that means removing advertising you know I know you talked about that this morning you know that means that everybody and you have an outlet for that adrenaline rush that you seek at that age and Iceland sports and Finland is like you know the artisans or it could be sports you know it's your hobby it's your passion you have a place to channel that to take risks so you work with with the brain around that so I think it's that communication Iceland they spent a lot of time on family spending time together and measuring what that looks like you know they still as a society they'll tell you like parents as it's coming up to a school holiday or whatever you'll get an email from the city of Reykjavich it's like don't forget there's a holiday coming up it's really important to spend time with your young people right so it's not focusing all the prevention language on the middle and high schoolers it's on the parents and the families and the society around it and it seems to help like you're not saying no forever right right you're saying protect this time Finland the flip is they they do things like they I visited Ulu which is a city sort of northern Finland they had designed our whole system so that a nine-year-old can navigate it by by themselves well so they have bike paths that never cross roads or they have bridges that you go over right and so you you're the nine-year-old you can get places so you can have agency you can be engaged and that's kind of their litmus test so what would it mean in Vermont if we sort of switched right and thought let's design from that level so that they can be engaged instead of trying to solve the problems after they're not engaged they can't have access to programs now they're bored now they're you know going down this way and then we we sort of come in did they also leverage that sort of co-collaborative parenting like I mean like you're right right if I don't like a particular video game and I won't have it in my house my kid can just get on his bike and ride down the street yes his friend's house you know and I I've completely lost control of that yeah and they leverage that and they do and we are because with their survey data in the Iceland case like we have data we know where are you so where they're accessing and drinking is not often in their own home it's the home the home of a friend when someone's not there where they're getting the substances and alcohol is from an adult friend who is not a family member so we're we're starting to learn these things you know so how do we you know the challenge is how do you get parents to also to come together the other story they kind of tell is this is Dr. Mann is one of their researchers and he's like if you don't think young people are coming together to fight against adults right and to like sort of outsmart all of us you're crazy they are so why aren't we sort of like hey you know if everybody in our kids friend group or whatever are all agrees to the same sort of thing it just takes that whole piece out we parent in isolation I mean and that makes it really hard because you have to have a lot of those one-on-one conversations instead of okay well where are you gonna go no one else is there you know no one else is out at that time everybody's in the after-school program everybody's in the summer program everybody's you know got a summer gig you know or something going on yeah I mean some of what you just mentioned the question that I asked prevention works was at the point of sale at least we can really we can train retailers to identify somebody who is under 21 but what can we do from an education perspective as a board to folks that are legally purchasing this and then going back to their home or their community you know what I mean and really make sure everybody's on the same page with respect to how this is gonna function in their you know cluster household whatever whatever you want to call it I don't know if you have any comments on that but I have another question the diet like a diagram of the brain science like put that front and center adolescent brains from the love what's still developing if people can get the message that you're not being kind to share or you're not oh they're old enough or something like that but you're actually impairing their future like their brain development their future growth like if we can understand that because we're not going to give a substance to a four-year-old because we understand that so we need to understand up to 2526 we need to understand that just as strongly I got one more question and maybe I should have asked some of our previous speakers this who might be more familiar with the data so when we when we think about the impression that some youth might have on other youth who use cannabis is there any kind of more nuanced data that goes into the types of products that seem cool for a lack of a better way to describe it that other youth or adolescents are using whether that's smoking products I mean I know that there's not really other types of cannabis products easily as accessible I would imagine in the state currently but is there any data out there that kind of you know what are kids attracted to more what are what are the youth pursuing if they're gonna you know band together against their parents and go use cannabis is it a smokable flower or is it edibles you know um I don't know if Dr. Vellanti has some of that and her yeah I was trying to remember and I should have asked that question we have and our data we have what are the perceptions and why like who's cool what we don't have it broken down within the type of substance but if you hang with any young people you can get that and for me right it's what others are doing it's good you go back to you know what's risky what's new what's bad what's the yeah I'm sure it changes week to week yeah so but oh yeah prevention networks talked about like the flavors like take out the things that make it you know fun and well I'm even I'm even thinking along the lines of okay let's say you have somebody selling at a retail operation and they're buying a parent is buying gummies and that retail operation can say hey just so you know kids are more likely to you know try and use these if you're not taking care of them responsibly or putting them in a place where they don't know if you're leaving them on your coffee table so on and so forth versus other types of products that might also be available in the store yeah well I don't know if we're at that granular level yet with research at least in the state I'm sure that there's some it seems like you'd address that with everything that's purchased right because yeah this might be cool this week but something else is the bad the next week right so the the information you give might be a little bit more yeah fair enough just thinking out loud on the other things on it and it is thinking about what we are doing as a society to allow this the marketing and the making it more and more like gummies and this and that right like you know they did you know I think it was prevention works was talking about anything that's going to appeal to adults is going to trickle down in some way too you know so for if as a society we're going to allow those if we're going to allow advertising if we're going to allow the retail store if we're going to allow that then how do we just like you know keep thinking about that protection and where we're focusing the responsibility for protecting their brains it's not all on the you know it's not all the education to the young people that's you know it's the to protect their own brains yeah I'm not trying to insinuate the one may may or may not be safer to use than the other but from the perspective of you know where is the most targeted education needed for this part of the community well I hate to cut this conversation short you know I know we got a little bit of a late start but thank you for being here absolutely you know this is obviously the beginning of the conversation and you know we look forward to doing what we can to kind of support mutually support our our admissions that's great and I know that we can make real and lasting change by investing in that third space change in the you know where young people are I notice your one slide just said you know 21,000 enrolled 26,000 no access is that roughly kind of the amount of youth in Vermont that would be participating yeah that the 26,000 came from a um it was a parent-based survey that asked you know if if you could would your child be in a young person and that that was the gotcha the estimate that came back from that so that's the best number we have that's the most recent that's a December 2020 number yep is that up on our screen no it's not okay okay well I thank you again sorry I just um we're a little bit tight on time this afternoon no I totally appreciate any follow-up questions anything I do to help support you've got some important decisions to make yeah um so thank you for thanks for this conversation yeah thank you all I really appreciate it well so our next guest is here Dr. Jenny Pearson is joining us from Nevada who has about a year head start you're an associate professor at the University of Nevada again you've worked very closely with one of our previous witnesses Dr. Andrea Volanti who presented earlier today and was just so incredibly knowledgeable I think I can say that you also serve on the Nevada Cannabis Advisory Commission is that right that's that's great so you know I asked if you would join us to kind of give just some of your thoughts about you know the issues that we're going to be facing you know as a state not just as the cannabis board but and how we can kind of address those head on and get ahead of them as opposed to kind of just react to them after the fact and so I know you know this can be a conversation you can kind of just tell tell us how you want to proceed but um we're here to kind of learn from you I think you're muted Dr. Volanti is is um as we say with the kids with my please forgive me I'm just going to kind of talk on three different topics and I'm happy to present in the future with more you know with slides with with you know p-values and 95% confidence intervals if you'd like to see those um we we uh we certainly have all that data but just you know time time we're very yeah we're very early on in our kind of in the life of the board and so honestly the kind of broad overview is actually probably more helpful for us okay great so I first because you know we don't know each other I just want to kind of give you a little statement of my kind of position on cannabis legalization and um what I want you all to know is I am incredibly supportive of legalization I think it was the right decision for Nevada I'm happy to see it happening I think it's the social justice and public health imperative and so what I'm really interested in doing is using my knowledge especially from tobacco control but now being in cannabis for about three years we we ended up having legal sales start July 1st 2017 so we've been doing this for a little while and I've had a study funded by the National Institute on Drug Abuse yep National Institute on Drug Abuse since 2018 looking at adolescent cannabis use and cannabis advertising so you know I just want to put that out there that I am very supportive but I would like to see us you know use regulations to align companies incentives with the kind of public health and public safety goals that I think states want to see right so I think pretty universally we all acknowledge and the data supports that the overwhelming majority of people over 21 can use cannabis without any problems and in fact with a lot of pleasure right it can bring a lot of positive experiences to people's lives and for a lot of people who have medical uses for cannabis it can really improve their quality of life I think there's a lot of research that still needs to be done on that but certainly people's individual experiences are very valuable and I've seen that myself in Nevada I think we could all also agree that we don't want to see increases in the population level either among people who are over 21 and perhaps have problems controlling their cannabis use there's a little bit of a misunderstanding that there's no such thing as cannabis dependence unfortunately there are not a very small number but there are people who have a hard time controlling their use there are people with certain personal characteristics that have are at greater risk of having negative outcomes associated with cannabis use for example people with schizophrenia if you use cannabis psychosis gets worse even though it feels from the individual level like it's better and then I think we could all agree also that on the people under 21 especially especially adolescents we don't want to see cannabis use in that group so I'm going to talk about three different topics broadly I'm going to talk about our experiences concerning changes in cannabis use among people 21 and over I'm going to talk about our experiences and changes in cannabis use among people under 21 and I'm going to talk about just my kind of general thoughts about advertising and marketing standards with the groups those the kind of subgroups that I'm going to talk about in those two first areas in mind so first and please feel free to stop and ask clarifying questions at any point so first among people 21 and over in Nevada we have seen an increase in the proportion of adults who have reported any cannabis use in the past 12 months perfectly fine I don't see any public health issues with that really we are potentially seeing a small increase in the proportion of people who report symptoms of cannabis use disorder like wanting to reduce their use and not being able to but that's just like a little hint so I can't really say for certain if that's true or if that's just something that's a blip and it's going to go away the two groups that I think are most interesting among people who are over 21 are older adults so people 65 and older and pregnant women so among people 65 and over I've done a decent amount of research with Nevadans and older Nevadans and what they're telling me is that they are primarily interested in cannabis as a alternative to replacing prescription medications that they're on so for example pain medications sleep medications and this is totally understandable in a world where you know we're hearing all about the dangers of opioid dependence the idea that there is now a product that you can just walk into a store and it's labeled and it's it's often medicalized which I'll have more thoughts about that but you know it says how much THC is in and how much CBD and they feel like it's more like medicine right they can take a they can use creams they can use an edible to them it feels more like a medicine and it feels safe and therefore they're interested in trying it out no I the older folks that I've spoken to about this the majority of them say I tried it it worked for a little while and then it stopped working essentially they developed tolerance and they got to a point where they weren't really willing to use more than that and so they went back to their prescriptions okay fine what the really the only thing that kind of came up there for me that was particularly concerning and that I would like to give you all a heads up is I heard a lot from older adults that they were unwilling to speak to their physicians or their pharmacists about cannabis use they believed that's that either their physicians were not going to tell them the truth or that their physicians would lose their license if they did tell them the truth and so that essentially their physicians were were automatically not going to share true information with them and that makes me concerned only because of cross pharmaceutical interactions so if you are on multiple pharmaceuticals and then you decide you know I don't like the side effects from my arthritis medication I'm going to drop that I'm going to try to place it with cannabis you know you talk to your friends you talk to someone who works at a dispensary and they give you certain feedback you decide to go with something and then you don't disclose that with your physician or your pharmacist we don't know if that's going to make certain medications less effective if that's going to make certain medications more I don't want to say not more effective but we just don't know what's going to happen right and so I want to put that on your list of things to be aware of is perhaps you need to communicate with folks both with physicians and pharmacists about seniors concern that maybe they need to explicitly ask about cannabis use and say look I'm not going to judge you and this isn't illegal it's fine I just need to know and on the other side encourage people who are on medical multiple medications to share this information with their physicians and to ask their physicians about what they know about cannabis so that's that's one thing the second thing is we're seeing whispers in the data and I say whispers because it's actually really hard to collect an adequate sample of pregnant women to answer this question but we're seeing whispers that pregnant women are turning to cannabis to deal with morning sickness in the first trimester and this we've also seen a little bit of data on this from Colorado for example and unfortunately they're getting this this advice both from certain medical professionals for example perhaps doulos are midwives and though I don't I don't want to I have midwife I'm midwife friend who would say I would never but there's there's a few people specifically in Las Vegas I have in mind here and then also unfortunately dispensary employees who are giving medical advice that are not medical professionals and so we really don't know what this is going to do so prior research on cannabis use in pregnancy is really difficult to transfer to today because first of all today's products are very different than the products that were you know around even 10 years ago but also a lot of women who use cannabis in pregnancy were also using tobacco specifically smoking so it's really hard to tell if the negative outcomes associated with cannabis and or tobacco use are due to cannabis or due to tobacco there's it's confounding so you know when people ask me like is this a good idea I go and all kind of values is what I want to see is truthful information that prioritizes the individual and not selling products to people I center the individual here not the company's you know goals of making money and so if there's any sort of implicit or explicit health claim I want to see that health claim backed up with gold standard data and not anecdote and not well we didn't say that explicitly therefore it's not it's okay no people have a right to truth and not being misled and and so I am concerned about this because because I think women are probably thinking they're doing the best thing for themselves and their babies and we don't know if that's true I'm not going to say ah it's terrible you know that I don't have never do that we simply don't know and I bet most pregnant women would not want to hear that they are guinea pigs so so that's my other concern about people over 21 any questions or or anything about that yeah yeah I do have a question about that I mean given what you're saying given the lack of this data if we wanted to have kind of a bud tender and I don't know if that's the proper terminology but if we wanted to have a bud tender educational program which we're required to do I mean what are we supposed to rely on to help educate them okay well bud tenders are not medical professionals and should not be giving medical advice done right if someone comes in and says look I'm having terrible morning sickness can you recommend a product for me to help me deal with that the bud tenders response is no I can't but they might say but anecdotally you know this drain over here might help that's the problem okay that is the problem you are not medical professionals you are not you should not be giving medical advice and and I you know when I look at you know descriptions on weed apps for example for the like on the menus for nevada dispensaries I also see not necessarily explicitly use this for morning sickness but I see this product can reduce anxiety or this product you know and it's like okay great show me the data right because because for some people yes okay for some people cannabis does reduce anxiety for some people it amplifies anxiety so you know I these are all medical claims that need to be backed up with hard research not anecdotally does nevada have a blood tender educational both like certification that they that they have to go through yeah but I don't know very much about it my impression is that it is mostly having to do with keeping you know ill the illicit market and like organized crime out of out of the the legal market so so full disclosure the cannabis advisory commission it's meeting for the first time next month so I'm sorry not next month next week next week so I've had a lot of individual conversations with folks but we have yet to officially do something like this okay yeah ours hasn't met yet either for what it was yes okay our advisory committee has not been assembled for you right right okay anything else none of this time okay all right so for under 21 very interestingly this is this is kind of my main focus and we're doing a big analysis of youth risk behavior system survey data we're comparing states that legalized cannabis between 2017 and 2019 to those that just had medical campus cannabis and what we're seeing is when you look at any past 30 day cannabis use which is often kind of defined as current cannabis use among adolescents any past 30 days so that could be one time that could be a thousand times in the past 30 days you know it covers a big range we don't see any any evidence that legalization leads to an increase in past 30 days no no it's flat and that's pretty consistent across a few different published studies using different data sources no haven't seen anything however and by the way I should say that could change that could change that could increase decrease we don't know because keep in mind that's just one year after legalization right so so just keep that in mind um among students high school students like certainly it's flat it kind of looks like if you're a past 30 day user in high school you're already like you're gonna be a past 30 day user whether or not there's a legal environment or not we might be seeing a little increase we see a little blip in Nevada data so essentially we might be seeing a little bit younger age of initiation um perhaps due to perceived norms perhaps due to lower perceived harm of getting caught with it for example I've certainly heard that from young adults we haven't we haven't explicitly asked that of middle school students but again it's a blip we're gonna have to see if that sticks around as those students mature we have seen however a pretty decent increase in intensity or frequency of use among students who are already past 30 day users so essentially if you think about you know that kind of the range of kiddos who have used cannabis in the past 30 days the majority of them used once or twice but we're seeing among states that legalized a shift towards a higher average number of times used in the past 30 days and that that looks pretty robust we also see something like that among young adults and that data that that research is like currently ongoing right now so you know give me a month and I can give you a point estimate 95% conference intervals and p-value so and we're also seeing that adolescence with a history of trauma or with current mental distress like depression suicidality anxiety those are also the ones that are at highest risk of of an increase in intensity and frequency those are already the kids who are the most likely to be cannabis users or polysubstance users and then those are also the ones that are seeing the biggest average increase in frequency of use and that is concerning because those are the kids who are the ones that are most likely to have long-term negative consequences due to substance use not just cannabis but just substance use in general so you know when you think about how you're going to spend your public health dollars you might want to try to focus intensely on the group that it's going to have the greatest risk of long-term harm and honestly the greatest risk of being you know of using public resources for example whatever Vermont's version of Medicaid is you know so you know it's both a practical and kind of a moral imperative so yeah so that's that's by kind of general overview as to what's happening with cannabis use among adolescents in Nevada do you have any questions there yeah yeah so and I don't think you touched on this but maybe you did so maybe this question isn't relevant anymore but you know one of the early argument for tax and regulate is that you know the person who's willing to sell a youth cannabis they're also willing to sell you hard drugs or you know cocaine heroin or something along those lines you know that is at least an early argument that was being made so you know I'm wondering if you saw either a decrease or an increase in other drug usage past you know 30-day drug usage post-legalization if anything we're seeing a decrease in alcohol use I'm not a hundred percent sure that's going to stick around but if I had to bet that's that's what I would bet okay thank you yeah and that's we're seeing that also in the monitoring the future data which is I apologize I missed something that you said you said there was a younger age of initiation is that in states with medical legalization or retail and medical I missed a piece of what retail and medical yeah and I but I'm specifically talking about Nevada yeah sorry I should have been more clear about that yeah in Nevada data we are seeing a trend towards younger age of initiation of cannabis among middle school students so students ages 11 to 13 maybe so you know when we get the 2021 data we'll we'll see if that's continuing so in that in that data are you are you all looking at like differentiation of products or is it just cannabis usage generally speaking good question so we have a question in the high school survey asking what was the most common way that that they used cannabis I'm sorry in the high school and middle school what was the most common way that they use cannabis in the past 30 days and it's overwhelmingly it is smoked flower but we saw a big increase like a double aid of the proportion that said vaping cannabis between 2017 and 2019 so among high school students I believe it went from 7 to 14 percent I don't wait was that middle school or high school I would need to definitely bump oh yeah yeah until we see it a bump yeah a big old bump and and you know also when you're thinking about just data that's our data is really shown that like the adolescents don't really differentiate between like vaping is vaping to them and so you really got to ask them what do you think you're vaping do you think you're vaping nicotine do you think you're vaping cannabis do you think you're just vaping flavors because you know a lot of researchers especially from tobacco we tend to think oh vaping means nicotine and it's like that just doesn't reflect how adolescents vape not at all and the products don't have one near me right now but like hey I vape cannabis I know you can you can screw all like the the battery for for a vape can vape can vape a cartridge of containing whatever you want it to contain it might be a little less efficient for vaping cannabis oil versus you know a nicotine solution but like ultimately it'll work and you know adolescents don't really care how you know what the experience is like so that's just an important thing to keep in mind thank you yeah so my final thing it's a little bit of a soap boxy thing but we have quite the interesting advertising and marketing environment here in Nevada so we used to require dispensaries and brands to proactively get their advertisements cleared but then that switched to a passive kind of you know will come get you if you do something obviously against the rules approach in a boy like about a year and a half ago so in my humble opinion the Nevada standards leave very much to be desired when it comes to accurately conveying information and also when it comes to protecting people under 21 from seeing advertisements because the reality is is that advertising 100% increases the use of our product we see that for alcohol we see that for tobacco there's no reason why that's not going to you know translate to cannabis however cannabis is unusual because we have now a legal industry that can advertise and that has really strong age controls and does not sell to people under 21 like that that's not been a problem in Nevada or anywhere else that I know of they're really good at age controls however we have an unregulated illicit market that like you said does not care what your age is so essentially you know we're advertising products that okay perhaps specific brands aren't available on the illicit market but the the general concept of you know smoking pot is is being promoted and then is easily accessible to people under 21 so this is kind of a unique environment where I think we really need to be careful about the specificity of marketing channels meaning you know billboards that's the buckshot of advertising you know you can't say no one under 21 is going to walk past this billboard right of most states say you can't put a billboard within 500 or a thousand feet of a school well that's nice kids go outside like beyond that right and in fact in Nevada where are they put they're put on major highway which makes perfect sense you want to get as many eyeballs on it as possible but those eyeballs are of all ages so if I had my brothers Nevada would not have billboards because they are non specific advertising that does not restrict to for example you know a channel that the general kind of standard is if this magazine or this website or this you know whatever channel has a 30 percent or greater underage viewership then you cannot place the advertisement there right you can't say such a thing about billboards it just doesn't exist so you know we have certain content standards but those content standards clearly a bunch of adults got together in a room and were like kids like and they were said cartoons and candy and you know no sports you know sponsorships which is fine but the reality is is that there are lots of other things that kids find appealing and there are a lot of the same things that adults find appealing so things like you know we have a we have a brand here that features skiers and mountain bikers and and people doing yoga and it's it's a wellness angle but it is very it came up so many times I did a like gosh eight focus groups with youths all over Nevada both Ruraly and and in our major cities and that stuff came up over and over and over again so you know I do encourage you to think kind of very critically about you know how you're going to protect people under the age of 21 from from seeing advertisements and then my final point is that I think and I think in most states um the kind of medicalization and the medical approach to to cannabis to medical cannabis has leaked over to the recreational market so for example we have a recreation dispensary here where all of the employees were scrubs and lanyards like their medical employees this to me is going back to my kind of fundamental you know center of the individual people deserve accurate information this to me gives puts a medical halo around a recreational product and misleads people into thinking that what they're getting is perhaps a medicine now people who go to medical dispensaries after getting you know a a prescription from a physician they're working with a physician hopefully though I understand that's not always how it works but you know they have a purpose they go into a medical dispensary I like fine okay that's a different situation but a recreational dispensary to me even the concept of a dispensary it's it's the little it's medical as I it's medicalizing it is we don't consider a liquor store to be an alcohol dispensary we don't consider a tobacco store to be a nicotine dispensary if it's a recreational cannabis shop it is that's what it is it's not a recreational cannabis dispensary and so I encourage you to kind of step back and think what is it about about the medical the medical regulatory framework that we should keep and what about it is perhaps not appropriate for a recreational drug it is a recreational drug now and it also you have to think about the seniors for example who are hoping that this product will help them deal with some issue and think about the people under 21 who perhaps are are are getting a misunderstanding of the potential pros and cons of cannabis use because of this framing right it is I want to just universally center the individual the individual deserves truth in advertising and and and and the the companies should should kind of their their their goals of of you know promoting their products should be lower than the goal of communicating truthful information individuals so that is that's it I do have just I know we're running a little short on time I apologize because this has been incredibly insightful and you know talking to someone who's been through it you know for a few years now is just exactly what we need to be doing how long until we have some like hard science I mean I know like people always kind of quote Israel has been a few years ahead maybe Canada some of these other countries but you know when I talked to my primary care physician about cannabis you know she doesn't really know a lot about it she's prescribed it to there's some of her patients but you know it just isn't part of the training there's not a lot of hard science out there and so how do we you know if bud tenders can't give this kind of advice and doctors aren't really willing to or maybe they don't have the kind of hard science like half where I mean where does that leave us really regulatory perspective I think that leaves you at I think it's that kind of easier for you honestly because if the answer is I don't know you know to does this reduce the anxiety I mean maybe it's does maybe it doesn't then the the truth is I don't know right and therefore the company in the in a world of I don't know a company does not get to promote the you know therapeutic values of their product in that world now I think though I still think that's coming from a very medical perspective that question from a public health perspective as a recreational drug which I think is utterly 100% appropriate like we should be thinking about this product as a recreational drug right like we would never ask the question should should bullet whiskey be allowed to claim that using their product reduces anxiety I can tell you that it does I have used it that way but recreational drug none of us are wondering like we don't have the data should we or should we not like no it's a recreational drug that's not an appropriate claim now if that if bullet wants to go through the regulatory process in order to be recognized as a medicine and make medical claims and they should go for it but if you're talking about medical recreational drugs it's kind of a moot point like just it's it's a recreation yeah your point about making them yeah any other questions for Dr. Pearson I don't know if it's a question but what I found what you said about billboards interesting we we actually don't have billboards for anything in Vermont but New York state is only an hour from my house or less than an hour from my house and they have billboards and well and I don't know what they'll do about their cannabis advertising yet because they're still coming online right that's right and the same is true with Massachusetts and I'm not sure I haven't been to Massachusetts since COVID started I don't know what what their rules are but it makes me wonder and I guess I'm saying this one of my colleagues if there's a regional conversation to be had for sure that would be for our awareness yeah yeah that would be great yeah and and I I don't know if you've looked at Canada's warning labels either on their products but they they do a great job I mean it's not billboard related but they do a great job with their warning labels because they are just straightforward you know we don't know what's going to happen if you use cannabis in pregnancy the end you know that to me that's a very compelling warning label like okay you know and they rotate them so that they stay fresh and and so you know I think there's a lot that Canada is doing right and you might you might want to take a look look take a look at them thank you very much yeah thank you really thank you enough for your time and and I you know I have your email address so I might be reaching yeah please do yeah happy to thank you okay yeah you're welcome kind of move on to my next meeting you all have a great to afternoon yeah you do the same thank you bye so um our next witness um I think has joined us um yeah John are you with us I'm gonna turn it over to you Kyle to introduce John hey what's up everyone a little bit of his background hey John glad that you're here thank you so much for joining us John shoes the CEO of puff creative John I know that and I I might mess up your your accolades I know that CEO magazine is named to you Colorado CEO of the year before you've run marketer of the year before you've been operating in this space in Colorado for for some time I know you have clients and many jurisdictions around the country that are operating in a legal market um John is also a graduate of Norwich's MBA program so he is familiar with Vermont and I know he cares about Vermont and the communities that we have here and I know his organization is very community centric I know he has the same of his clients so with that introduction John I may have left something out but I'm gonna turn it over to you I think you can re-enable Hey no no that was perfect thanks thanks Kyle hello everyone at Kyle's my name is John shoes CEO of puff creative super honored to be here like Kyle said you know I lived in Vermont for three years I graduated from Norwich's MBA program so these types of conversations are really fun to be a part of and come close to the heart my agency we've been around for like five years now I've been in marketing for I think eight or nine originally in nightlife and hospitality transitioning into cannabis you know honestly the original reason I got in is because I had so many friends struggle with opiates being from New Jersey and a lot of them use cannabis to help get off of opiates and that kind of inspired me to get involved in the industry and it's been a whirlwind since you know I was listening on the last conversation being in marketing and advertising the rules change I feel like daily sometimes and my clients deal with a lot of headaches too we work in about 20 20 or so different states some international work as well so it's a lot of moving pieces all at once we handle a lot of people who just have money and an idea so we're starting people from like square one in their projects and we offer services such as logo design branding messaging packaging design we do brand books and go to market strategies we also lead into you know custom website design development once that you know launches we do SEO social media email marketing photo video and then we have a bunch of different strategic partners we use for public relations and certain advertising solutions advertising is pretty tricky in cannabis each platform has its own set of rules and regulations that we constantly have to navigate so and as Kyle mentioned you know we do a ton of different community work all over the country and all of our clients are pretty much required at this point to do some type of community or environmental give back so it's really fun to help local communities all around the country I think we've through our one program we've raised almost $300,000 the past three or so years for different nonprofits all over the country and we recently just partnered with last prisoner project 40 tons brand and released our educational guidebook series which is which is really fun anyway that's kind of my feel about about us in our perspective with my company I know today we wanted to touch on child compliance you know I got brought into the conversation because you know that from a marketing advertising standpoint and as I mentioned we deal with companies from the start so child compliance comes into play right away in the conversations that we have each state that we do work in they all have their own separate rules and regulations around child compliance throughout an entire marketing life cycle there is a lot of crossover and similarities but it does get a little bit tricky so we end up having to work pretty closely with different folks in the packaging side of things and the product development side of things and the advertising side of things because there needs to be a lot of eyes on marketing and advertising materials you know another thing I mentioned is that each channel differs in rules and regulations so we're constantly navigating that as well for example cannabis clients are at risk again their social media shut down just out of nowhere it seems like cannabis profiles are plugged into even their own algorithm which is pretty interesting and makes my job really busy but you know the early conversations that we have with clients no matter what the state are you know what their product selection is and how that relates to child compliance is there are brands out there in certain states not all states with certain ones that have products such as gummy worms or you know something that you know children already consuming when they go to like candy store or something like that so that's something that we talk about very early on before we even do any type of marketing work you know in that case sometimes clients will just want to change the product the product or if it's something they want to if they want to be on teetering on if they just want to do a gummy and that you know that child conversation gets brought up a big point that's made is you know how are we going to brand and educate the consumer and people in the dispensaries who are selling the project the blood tenders on how to properly market that product safely after we after products selected and we do a go to market strategy for those products we dive into the branding side of things so in that case you know first step would be creating a logo design and brand name leading into the messaging in regards to you know child compliance and child safety a big you know topic of conversation always is not having a you know cartoonish style logo or something that's already child related there actually is pretty big brands out there in multiple states and some smaller brands in a lot of the states too who kind of teeter on that edge in that gray area and definitely have a lot of eyes on them at the moment that kind of goes back to just you know marketing and advertising and just cannabis rules in general being pretty early on in the grand scheme of things so anyway a big you know a big point that we try to do is to make it clear through the design of a brand and also the messaging that corresponds with the brand who that product is for who that product is going to be attractive to and how that product is going to be incorporated in the people's lives you know kind of teetering off the last conversation or piggyback off the last conversation you know there is the the medical and recreational side of things too so depending on if a brand is medical depending on brand is recreational some brands are both throughout the life cycle there kind of are some differentiations that come up after we brand after we do the logo design and some basic messaging for a brand we'll typically go into the packaging side of things again during this part of the life cycle we were pretty closely with different lawyers and also the packaging companies and their attorneys just to make sure everything is dialed in and there's no questions at risk because a lot of times folks have to purchase you know minimum orders you know 30,000 units 100,000 units so there's not really any room for mistake all around especially when it comes to the the child compliance side of things a lot of different states or pretty much all of them have a THC symbol that for products that are sold out of the cannabis dispensary and that symbol I think ranges state to state and it changes every now and then and it can be tricky for certain brands and navigate when they have to make those minimum orders also each state has a separate verbiage that they put on their packaging again there is crossover there between states but each one kind of has their own little niches and you know variances within that messaging on the packaging as well and some states even can allow you know 18 plus or 21 plus on the packaging depending on if it's medical or recreational another another big point in the packaging is depending on how your product is packaged we actually take that opportunity to educate folks so if you can include additional marketing material in your packaging or boxes it comes in that's a really great way to educate to you know who your target consumer is you know how they consume the product and what it's actually for you know after that you know we usually do a brand book that dials in the messaging even further and all that will correlate onto the website the website is typically the first touch point besides the physical location of most of the consumers are going to dispensaries to make purchases the first thing that happens when you go to a website is an age gate portal that's something that you know identified with you know be related to this conversation and what happens as soon as you land on that site depending on if your dispensary is if you're a medical purchaser or a recreational purchaser you have to plug in your birthday sometimes additional info depending on the state to even get into the website itself other you know a lot of dispensaries a lot of cannabis brands use their website as well to publish educational material for folks and their consumers in some states that we've worked in I believe that we've plugged in you know a lot of different child safety and like parent safety and parent education material and the websites and the blogs or you know share links on social media related to those topics there are there there is a lot of fun and really helpful information out there if you start diving into it which is which is really cool brands and organizations also like to put just like basic 101 information about different products how they're used you know the science behind them consumption recommendations on you know how to properly consumer utilize the product and the other safety information most you know companies for example like Edible's company will have you know start start small you know micro dose you can always take more concept for consumers another aspect of the digital marketing I'm sorry I'm just like blurting all the setup I don't know if I should stop and answer questions or not but should I just keep going you're doing it yeah I mean you just get to a point where where you're ready for questions okay cool I'll be there in a little bit here so yeah the next area you know a big area where I think you know children and you know younger folks are have access to the brands or organizations or dispensaries to social media certain platforms and a lot of platforms actually have age gates on them themselves what's great about social is a lot of times I believe birthdays are associated with it so you know they'll be able to verify that age before they can even go to the page but not all social platforms actually do this believe every state or at least every brand that we work with or dispensary work with they have age limitation in their bios as well to make it clear who the consumers are who are allowed to view the products or the information on those pages uh basic rule of thumb for cannabis brands and the dispensaries especially is having no consumption content that seems to be just something that either gets flagged on social media pages and is just kind of foul play and it's been a rule of thumb since I first got into the industry about six years ago or so we try to stay away from call to action content on social media as well we try to stay away from posting pricing information and we also try to stick to more educational focus which is great social media can be a really really critical tool for brands to get solid info out there but again there's just a lot of limitations there but there is ways to kind of keep the content safe and also limit who is viewing that content which is nice same thing with advertising and from my perspective you can view advertising as like a digital average ad or also physical ad I know there was billboards talked about in the last conversation and it was mentioned you know Vermont doesn't have billboards but New York does it's a really cool point we work with a lot of different dispensaries that are on state borders and a lot of their sales come from outside states and a lot of advertising physically and digitally is done in those states even though some of them aren't necessarily legal yet so from an advertising marketing perspective each state has its own set of advertising rules and limitations but typically the content that we put out from a design perspective is just very well branded has the main information you know location what the business is and most dispensaries and brands in general are kind of sticking away from using green and cannabis leaves some advertisers don't allow that type of content at all in some cases we have to get really creative and do some type of collaborative partnership for ads but yeah that's kind of a lot of the areas that like we face like on the day to day in regards to you know child compliance or you know child safety is brought up it's something that we need to consider most of the time we're again we're working with different attorneys all across the board and different compliance officers to make sure everything's on point there's a whole approval process for each one of the deliverables we put out so in that case I guess I can just leave I think that's all I had to say so I'll let any questions or thanks John yeah hope that was helpful any questions for John yeah I have a question for you John how have when you're talking about packaging how have various retail operations handled you know labeling their packaging with the strain in such a way that it doesn't look appealing even when the the theme of the strain maybe is a superhero name there are quite a few of those or other names that just by the name birthday cake for example might be appealing to children how do they handle that I mean you see it across the board fortunately for us in those situations we advise our clients to again you know be as safe and long-term as possible a lot of our clients won't even select those names that are in that gray area I personally have just been noticing as of recently there being certain lawsuits because of the I believe skittles I want to say is in the middle of a suit right now with a strain that's very similar to the name so for us personally we always advise and work with attorneys to teeter away from that and not even advise brands against those strains and also if they are using those strains they're for the creative not to have like for if it's birthday cake or cupcake strain or something like that to not have it be child like so it would be more of like cleaner focusing on the colors of the brand to stay away from that but that being said you know like I mentioned earlier there's brands all over the country who don't are not you know practicing that so you know as from what we see I feel like things are going to be a bit more clean you know stricter as thing progressing cannabis so I hope that answers your question yeah thanks thanks John yeah thanks for joining us John yeah so you know we as a board are going to have to approve every advertisement we have that authority under our law some of the restrictions that we have the prohibited advertising or any advertisement that appeals to a youth under 21 how should we as a board think about that I know you mentioned the kind of cartoon colors and that kind of you know certain elements fonts but you know we also just heard from you know Dr. Pearson that you know like trying to appeal to people like you know associating us with like snowboarding or extreme sports or something like that might also appeal to a youth under 21 so how should we as a board be trying to evaluate that question of whether this appeals to a person under 21 I mean it's definitely going to be tricky I think the best way to help avoid it initially is bring up these points to brands and businesses who get license approvals before they even really get started you know as I mentioned like we're having these conversations and before these these brands are even coming to life when it comes to like you know and I guess from an advertising perspective it's all about reach for us you know I thought I think snowboarding's a good topic because yeah like it could apply to someone younger for us you know content that is more questionable is more exposed on like the organic side of things so you know very small campaigns here and there whereas like big advertisements on like billboards or large digital campaigns with like big advertisers there needs to be more of like a safety check you know and guidelines before anyone even touches any creative that makes sense so you know you can save people like me a lot of time going back and forth with folks like you you know if those types of things are just like set in stone like hey you can't have anything related to lifestyle content consumption you know call to action style content it almost seems like there could be and in some states there is this you know limitations on the specific info that can even be on there so that's really helpful I got one more for if you don't mind yeah so I think we have in our you know we have a statutory structure around advertising we have to develop specific rules around it you know we have a pretty typical but I think it's actually more restricted than most states that you know we can't have any advertisement in a publication or a medium that we're 15 percent of the audience is reasonably expected to be under 21 I'm sure you've worked in a few states where they have something similar you know Nevada being one of them we just heard has a yeah how do we how do we go about evaluating that I mean obviously some things would be easy television billboard you know things like that but you know certain types of magazines I'm trying to think like yeah so yeah so there you'll see like you know a lot some states won't allow it anywhere except for dispensaries in that case there's actually this cannabis specific magazines that you'll only find in dispensaries and that's like a cool way for brands and stuff like that to get the word out there safely because even enter the dispenser yourself there's the ID check typically at the front door so that's like one solution there how to check like how each publication and business and how to regulate that I'm not a hundred percent sure what I do know is that with any time that we do a campaign with an advertiser whether it's a local national international you know same thing with publications print etc they each have their own set of state regulations and guidelines that they send us that we that we follow when we're kind of you know executing any type of campaign so you know for example like I think in some situations I can't pinpoint the state exactly but I want to say there's that percentage rule in a few different states or one that we're doing advertising in and the only thing that could be on the ad is literally just the logo nothing else that's it and some brands will like pay to do that and I think that's how certain magazines are playing it safe but again I know a lot of states and a lot of publications and advertisers just not even allowing it in general so I got one quick I got one quick follow-up John yeah I actually I actually the question for you guys great in that in that regard is you know that is going to be tricky to track because there is you know if you look at a display ad campaign so like the ads you see on like bigger larger websites I guess it's not really a question just something to bring your attention but you know there's display ad agencies all over the country that just have ads that pop up on the sites and that's a huge play for big cannabis organizations I'm sure probably a lot of people on this call have seen some for big companies like weed maps you mean like on a site all those ads that pop up on the sides yeah yeah those those websites partner with different like display ad agencies so I think yeah so it's you know I think that the display ad people from a digital perspective they follow more federal guidelines and now it's going to be a bit harder to probably track well thanks for putting it on yeah putting on our radar I had one quick follow-up I guess well to this and to Pepper's point earlier around you know what can what can we do on this 15% rule because you know I know that you mentioned social as being a medium that that businesses in this space are really looking to and you know kids these days are on every single platform how like in your experience and I'm actually I never really thought about it from the perspective of birthdays and like ads kind of getting tracked from your age perspective to on Facebook and Twitter and so and Instagram and TikTok or whatever the case may be but I know you said that not every platform utilizes that type of technology but but are is that effective like are they good at I mean I know a kid can put in a fake birthday if they really want to right but like how effective are those you know gatekeepers yeah so I think it ranges again like we do our due diligence so a lot of the different like digital plug like from a website perspective it really depends on the plug in and the technology that you utilize and it is effective in some cases but again like yeah there are there totally are workarounds and there's going to be developments and there are developments that are happening every day from a website perspective on compliance and safety and like how people can actually get into websites on the social media side of things is a little bit more effective especially if you know one's Instagram and Facebook are linked but again there are platforms you know Twitter for example I think you know TikTok there are no you know age verifications on those but in those cases you know same thing with Facebook and Instagram accounts get plugged into an algorithm that's what social media is now in on every platform there's limitations with cannabis so in most cases the content that is allowed to go through on business profiles for cannabis accounts especially dispensaries and brands who are making actual sales yeah it's it's tricky and like you have to be safe anyway so yeah I think I think I think over the next I would say you know even just one to five years the technology on plugins and verifications what not is going to be drastically different but there's still there's still a long way to go all around in the industry thanks John yeah I really appreciate it we're on a little bit of a tight time yeah no worries I know I started a little late too I tried to squeeze it all in you know we certainly appreciate it I think this is not the end of the marketing advertising conversation as we get going so we're hopeful we can tap into your knowledge somewhere down the road yeah more than happy to talk anytime I hope everyone have a great rest of the day I really appreciate you having me thank you thank you so next on our agenda is public comment we have very little time unfortunately we do have some folks scheduled for our executive session at 245 so if people have public comment could you please raise your digital hand and we're going to try and limit it to one minute per person I see Dr. Anthony feel free to unmute yourself and put your video on if you would like Dr. Anley are you with us if you just unmute yourself you can provide public comment all right well what we wait for Dr. Anley is there anyone else that would like to provide public comment right now please just raise your digital hand it's Catherine Anley can you hear me yeah yeah okay yeah thanks for taking my my call I just couple things we wanted to comment on so I'm a member of a group that's recently formed international academy on the science and impact of cannabis we have world leaders on medicine and cannabis and our website is I a s I see the number one dot org and what's nice about sure I like Isabel a like and s like Sam I like Isabel and see like cat the number one dot org and what's nice about that website is that there's a library there which is useful for physicians but it's also useful for lay people and it organizes all of a lot of the literature pertinent literature all of the articles you'll find there are well done powerful you know controlled studies and they're actually like 15,000 peer review articles on cannabis at this point so that's like the one one of the more important things I wanted to talk about the other thing is this issue of kids not increasing use there's a couple of issues with that one is for example in Colorado half of the state has opted out but that number includes the whole state and I just heard testimony in Boston last week and they've done studies on a granular level a little bit like what Holly Morehouse was talking about and they're finding increased use you know in a particular school and so it's it's it's and the and the other piece to that is that if you look at the ER data Colorado and is seen and so is California huge increases in kids showing up in the ER for these you know poisoning psychotic episodes cannabis hyperemesis syndrome so it's like your expert witness you know said you're you're you are having some kids the kids that are using using really high potency and a lot of product and I don't know you must have heard there was a a bill that just went through Colorado last week where a lot of the legislators testified that their own kids have been you know caught up in this and so they're they're trying to do what you're doing right now you know let's decrease the the THC let's get this you know the candies the sweets the advertising out of this so we don't have this this problem and from a lot of I know you've got a lot of other people to talk to talk yeah thank you for that and thank you for the resource it was directly responsive to a couple of our questions today so that's great I'm going to stop public comment there I don't see anyone else's hand raised and I will just next on our agenda is to move into executive session so I'd like to entertain a motion to move into executive session to discuss our consultant finalists so I would move to move into executive session to discuss our consultant finalist I will second all in favor hi hi hi so Kyle could you please pause