 I am JoLinda LeClaire, Director of Drug Prevention Policy for Vermont. I oversee the Governor's Opioid Coordination Council, which Governor Phil Scott established by Executive Order in January 2017. Since then, the Council has focused on its mission to improve Vermont's response to our opioid challenges through prevention, treatment, recovery, and enforcement. This crisis touches everyone in our state. Many Vermonters have family members and loved ones who have become addicted after receiving opioid prescriptions for pain. Others were exposed to opioids and other drugs through friends, dealers, and traffickers. Regardless of how they were exposed, we know we have among us many who now have the chronic isolating and too often deadly disease of addiction. We are making progress. Treatment is available across the state through Vermont's nationally known hub and spoke system of treatment. Recovery centers in our communities are providing effective wraparound support to help people achieve long term recovery. Many communities are building prevention coalitions to provide our children and families the tools they need to be resilient in the face of life's challenges and traumas. Vermont law enforcement has steadily worked to increase community safety and to decrease the supply of illegal drugs. They also work hard to support prevention strategies that will reduce the demand for opioids. There is more we can do and must do to turn the curve on Vermont's opioid challenges. Drug prevention education is a top priority for schools and communities. Increasing intervention opportunities in emergency rooms and other places will help more people enter treatment and recovery. Individuals and families in recovery need support to obtain jobs and rebuild their lives and support for harm reduction through safe and appropriate use and disposal of drugs and syringes will increase safety in homes and communities. Something we all can do to take every opportunity to raise awareness and reduce stigma by talking about addiction. To highlight the science of addiction as well as the cultural, social and economic challenges associated with addiction. The producers and hosts of Vermont Cable Access and the Opioid Coordination Council have created an eight-part series entitled, Understanding Vermont's Opioid Crisis, Working Together to Create a More Resilient Community. The fourth in the series is about prevention, school and community-based. Beginning with efforts to ensure our children, schools, families and communities have the skills, programs and support they need to thrive. In this segment, host Ed Baker talks with guests about the Opioid Coordination Council strategy to promote a comprehensive statewide approach to school and community-based prevention, statewide prevention messaging and effective opioid education for healthcare providers and consumers. Hi everybody, welcome to our show. My name is Ed Baker and I am the host of Understanding Vermont's Opioid Crisis. Thank you, Jolinda, for your introduction. As Jolinda mentioned, the focus of today's program will be prevention. The prevention efforts that Vermont has begun as a result of Governor Scott's initiative of 2017 and the Opioid Coordination Council's work since then. In order to help us understand prevention efforts in Vermont, I have three distinguished guests with me today. Mariah Sanderson, who is the Director of the Burlington Partnership for a Healthy Community. Anne Gilbert, who is the Director of Central Vermont New Directions. And Christine Lloyd Newberry, who is the Director of Integrated Wellness Program at Champlain Valley School District. I figured we would just jump right in and I'd have you all introduce yourselves and speak a little bit about your passion for this work. I'm Anne Gilbert and I'm the Director of Central Vermont New Directions Coalition in Montpelier, serving all of Washington County. And I'm passionate about prevention because we do see that it works. I've been working in the field for almost 15 years as a parent educator through the Family Center and running after-school programs. And now the Director of the Coalition with funding for preventing tobacco use and alcohol, marijuana, and prescription drugs. And I'm Mariah Sanderson. I'm the Director of the Burlington Partnership for a Healthy Community. So our coalition has been around for about 10 years. I've been the Director for all that time looking at how to address the causes and consequences of substance abuse in Burlington. And we do that really by looking at strategies that are about changing the environment that people live in. So we're looking at changes to policy and practice, public awareness and education components. We're looking at we are implementing programs for youth around youth empowerment and leadership to help them have a positive change and influence on their community. And then we've also recently started doing some parent education work as well. And so I've been doing this for about 10 years and then prior to that I worked in the treatment and recovery field. So I kind of saw the struggles that folks were going through and when I had my own kids really wanted to be on the other end of that thinking about how do we help support people to make healthy choices from the very beginning. Thank you. My name is Christine Lloyd Newberry and I am the Director of Integrated Wellness for Champlain Valley School District. For the seven years prior to that I was the Executive Director of Connecting Youth which is the Community Prevention Coalition in the same region of the state. My passion for this is personal and professional. I started as a high school student in prevention programs very very early on here in the state of Vermont. And so I've sort of seen the whole arc of prevention over the lifespan here in our state and what has worked and some of what hasn't. I am also like Mariah said a parent and so this has that much more meaning for me. In the school district we really focus on how do we create a community for our students that enables them to not only make healthy choices but supports them in doing that. We talk a lot about resilience so we'll probably talk some today about adverse childhood experiences but the truth is whether you're in a school or in the community you're a parent you're an educator or just a community member everybody has a role in supporting kids in our communities and so that's really the lens that we try to look at look at all of this through. Thank you. Thank you so much. You know the subtitle for the show is working together to create a more resilient community and I can't think of three people that more exemplify that sentiment so thank you for your work and thank you for your dedication. You know for the viewing audience I thought it would be good to just begin at the beginning but it's just a thumbnail definition of what exactly is prevention. I'll just throw that out to the panel. Well I think I'll just jump in and say there's there's a lot of different ways that people define prevention so I'll say that for the organization I work with and some of the work that we're doing at a county level and a city level we're defining it the way that the substance abuse and mental health services administration does which is to say we're looking at prior to the onset of a disorder how do you support people to not develop an addiction or dependence so we're really looking at what are the community the community initiatives we can be doing the school-based initiatives we can be doing the individual supports for folks that really help them to make healthy choices and make the healthy choice the easy choice prior to them developing a problem. To make the healthy choice the easy choice music to my ears. Do you want to chime in with anything or is that do you want to add something to that? Well prevention is really stopping something before it starts and many times unfortunately but fortunately we learned from experience you know when there were lots of kids with head injuries we decided you know as a country we need bike helmets you know and ski helmets seatbelts and so we're really looking at what are those things that can really help our youth and our families now in preventing substance use disorders. Thank you. Do you want to add something? No. Pretty comprehensive. Great great great definition and from there I guess I'd like to go to the the youth risk behavior report of 2017 just issued in May of 2018 which there is like a resounding example of prevention on this and this report specifically with regard to cigarettes that Vermont has reached its goal the Healthy Vermonters 2020 goal was to reduce cigarette smoking amongst high school age students by 10% and we've surpassed that. In 2007 there were 18% of high school students using cigarettes in 2017 there are 9% so a full 10% of students or full 9% but less than 10% of students are now not initiating smoking. This is an incredible success. I'd like you to maybe because you've been around you've been doing this work all through this period I'd like to speak a little bit about or you to speak a little bit to what worked about that what is it that worked so well about that. If it's okay maybe even before we do that for folks who aren't familiar the youth risk behavior survey is a survey we do in Vermont every two years we've been doing it for over 20 years now so we have a really good data set in all public schools in Vermont take it all students in all public schools in Vermont take it so it's a really large sample and the results for for 2017 just came out last week so all we have right now are our statewide results but we will eventually also have individual county level results and school district level results so it's a great way for school districts or communities to look at what are the challenges that you're seeing and what are the successes and use data to help you build on. Just to speak to the magnitude of that it was approximately 21,000 Vermont high school students representing 69 schools where we're interviewed so this is a comprehensive study. It's middle school and high school level every two years and the public can access this information on the Vermont Department of Health website as well but like Mariah said we don't have the specific supervisory union data just yet and it's also a national survey it's it's a well-validated tool created by the CDC and so you can actually compare Vermont to other states across the country as well who are taking the same survey there are a handful of questions across states that are going to be different but the core set of questions is the same. So we can compare our progress to other states and maybe learn from someone that's doing a little better or maybe teach someone that needs to work better than that. But we are excited about the tobacco use going down and so you know what what are those things that have worked? I mean we talked about this a little bit before we all got together is that we really I think with when it comes to tobacco use prevention the master settlement dollars that our state received which is when the I think it was 1988 is it? Our state along with a bunch of other states sued the tobacco industry for lying to the public about the health impact of tobacco smoking and got a large settlement that we received every year and we put some of that money back into helping people quit and then also preventing new users. So we've been doing that for a long time which is why we've really invested in tobacco prevention in our state and you've seen some drastic results both in youth the youth data but also for adults too so the adult use rates have gone down significantly over the last 50 years as well and it was we took a comprehensive approach so we we did public education like I think right now I would say we've probably vilified smoking right like it's no longer cool to smoke it's very it's gotten to the point where you feel a little ostracized if you're smoking and that is a result of a lot of the public education that was done we also changed a lot of policies so back when my mom was having me in the hospital if she wanted to she could have smoked in her hospital bedroom right now today we would go that's awful right and people did but we've changed a lot of those policies right so because we we because we realized the health impact and also it was to help people quit so we made it a lot harder to smoke there's public smoking bands there's you can't smoke in most places inside and other states are not the same as Vermont so Vermont there's no public smoking inside but in some other states you still can so we've seen better results in other states as a result of that and we increased the taxes so it made it harder for people to or more incentive for folks to quit and harder for kids to start so we know that price is really determines whether kids will use or not to because they don't have the unlimited income like adults do so so price really impacts kids there's also been some like effective universal preventive messaging on TV yeah suffering from the consequences of cancer the mouth cancer the lungs on TV talking about this is a result of smoking or chewing tobacco we did a lot of public education right so there are those messages that but there's also the absence of the other advertising when I was growing up there were always jingles and commercials on TV and the radio promoting cigarettes and there were cigarette machines and they were cheap and kids could even buy them and they were everywhere and so getting rid of all of that has made a huge difference absolutely and even as a parent of an adolescent showing him movies that I watched as a teenager in the 80s I'm amazed to see the prevalence of smoking and alcohol use in movies that were common for teenagers to be watching we don't see that anymore newscasters I can remember when I was a kid Santa Claus had a carton of lucky strike cigarettes sitting out of his gift bag so it was normalized so yeah that's the thing we know that having all of that kid seeing it all the time normalizes use and it makes it more likely that they'll pick up a substance so that was part of a comprehensive plan to to really reduce tobacco use rates we've looked at all of those things that were impacting use rates and and tried to make make it easier to make a healthy choice and as it pertains to youth one of the things that we learned very clearly as a part of the the tobacco settlement process and all of the science and research that came out of that time period was the longer that you can delay onset the less likely somebody is to pick up in their 20s somebody's not going to start smoking the tobacco industry is very very aware that their new smokers are teenagers and so the earlier they can can convince somebody to start smoking the more likely they are to develop an addiction over time and the brain research I think we had discussed this a little bit the brain research on brain development in the 20s the prefrontal cortex where people make decisions based on rewards and consequences is fully developed rather than adolescents kids are more impulsive so they make quick decisions and sometimes with terrible consequences so it seems I was just going to say there's a lot of good data that shows that 90% of folks who develop an addiction started before they were 18 so really know if you can delay just a little bit longer we really can make a lot of changes in terms of prevention we can really figure out the strategies that help us delay people using while they're in their teens and early 20s and speaking to that that's why we work with college campuses and you know universities who are now going smoke free or tobacco free there are over 1600 in the nation and many in Vermont which are now smoke free campuses so that if kids have not smoked in high school as we see on the YRBS and they're entering college if they're not in a smoking environment they're less likely to start beautiful it's real progress so it looks like we have some clear indicators about how to go and where to go there's reason for concern with the youth risk behavior report of 2017 specifically with regards to alcohol in marijuana alcohol use had decreased from 2007 to 2015 by 12% it's a profound decrease but between 2015 and 2017 it actually increased by a significant amount 3% same with marijuana marijuana had gone from 24 to 22% and from 2007 to 2015 and then that same period 2015 to 2017 we lost fully 2% so another significant rise why do you think that is that cigarettes had a continuous downward trend but alcohol in marijuana have now over the past two years of trended upwards one of the things that really stands out to me as it relates to this is with tobacco we really changed policy around tobacco we had long-term sustained efforts that changed access to tobacco among youth it changed where people are permitted to use so the how when the whole community environment around tobacco use was has really been solidified with alcohol we're still involved in that process and we're still working on on making all of those changes so we as we talk about restricting use for youth in our school district one of the things that we focus on is locking alcohol up in the home making alcohol inaccessible to youth we know that younger students who have access in the home they're getting they're not getting it from a friend they're getting it from the their liquor cabinet the refrigerator in the house or from the home from the home of a friend as opposed to somebody purchasing alcohol for them so looking at things like that would you add to that Mariah and yeah and and there are things that we are doing in communities you know restricting sale to minors but we really do need to have that message publicly you know like Christine said with tobacco there was so much less familiarity with it you know and exposure to it but with all the media and I think the the kids are looking to their parents and to policymakers and to the community to offer healthy solutions for them and to keep them safe and when they see you know legalization or still a lot of promotion of alcohol and of tobacco and of marijuana they're not getting that message that that it's harmful and so they have this decreased perception of harm and that's something that we're really trying to change yeah yeah I wondered about that when you look at protective factors and a few of them are the adolescents perception of risk as the perception of risk increases the willingness to use decreases a parental attitudes toward a substance or another parental use of a substance or another or the community attitude it seems to me that that this is a clear warning shot now marijuana and alcohol where you know we've begun to lose a little bit of ground so we have to begin to you know really increase our efforts to educate children and and parents it seems that parents really are are crucial or if not parents trusted adults in children's lives would you like to speak about that a little bit yeah I mean I can say I think again as much as all of the different places where kids are being influenced can reinforce the same message the more likely kids are to make healthy decisions so adults in the community we are one of the key factors for kids doing well right and how much we reinforce healthy decision making and role model appropriate use really matters so you know just I'm thinking of you know in my own peer group oftentimes I'll hear adults refer to alcohol as a way to relax we're talking about like I really need a drink at the end of the day but those types of things are the if you think about it kind of the opposite of what we want to teach kids you don't want kids to think of drugs and alcohol as a way to help them manage emotions or manage stress so us reinforcing those messages is really can be harmful for them and I'll take us back a little bit to your previous question because I wanted to add I think one of the things that was really successful with our tobacco efforts in our state honestly is the money that went into it so we as a state decided you know this costs us money like tobacco use is still I think it was the last I looked it was like 350 million dollars is what we spend as a state every year to address kind of the health related consequences that come from our current tobacco smokers it's a significant impact on our state budget so we you know we put money into tobacco prevention and cessation because we know it was an investment to support reducing that cost we haven't necessarily done the same yet with addressing other substance use challenges and we also didn't you know the tobacco settlement money gave us the opportunity to do that so there's you know there's different there's challenges with that but one of the reasons there's a lot of reasons why we could have seen an increase in some of in the marijuana and alcohol use but one of them could potentially be is that we've actually we lost some funding over the last few years that was going into prevention and our state funding to support or well our it's mostly comes from the federal government our funding to support substance use prevention kind of goes ups and down over the years and so that like inconsistency of being able to address a problem and be really targeted has been a challenge and it will make our numbers kind of go us have a hard time making consistent progress and so I think maybe our coming together isn't the place to address that challenge but but for communities that are thinking about what do we do about that or families that are thinking about that really as much as communities can think about how to make changes or individuals or parents can think about how they make changes that don't need the kind of support from programs so that that like changes in the home changes in the home changes to policy and a community level you like as a as a town you can make a lot of changes that don't require you know additional funding to the policy and practice so as much as we can think about how do we help both all the environment support kids to make healthy choices you shed light on one of my fondest hopes that from from the current situation this idea of funding up and down and not being consistent over time I do think that that day is over and the reason I think that is because of the gravity and the velocity of the opioid crisis in Vermont and in America I think it has grabbed the public's attention like never before and there's a groundswell of compassion and a groundswell of effort hopefully the governor's opioid coordination commission and the governor's policies you know will really grab on to that in a substantial way and we'll have a permanent see change in the way we operate so that generations of the future will not have to see this again and I guess what I'm hearing from you is one of the many things I'm hearing from you is the importance of partnerships that this is an all-hands-on-deck effort and I'd like I'd like the panel to address that like how do you develop partnerships and who do you see as your your partners in this well certainly in addressing prescription drugs we'd like to see even more education in the schools from an early early age because we know that kids have been you know poisoned teenagers are getting them from the medicine cabinet at home and educating parents about what they can do to provide safe use safe monitoring of prescriptions at home and then safe disposal we're working with hospitals and doctor's offices you know the supply they're they're not supplying as many pills as they used to because we saw that that was such a problem and and so now one of the things that I'm addressing in central Vermont in Washington County is the safe disposal so we've put a kiosk a safe collection box in every police station and in the Washington County Sheriff's Department so anybody can go in when the police station is open and just put their old medications get them out of the home you know not keep them around if they've had a shoulder injury or their their child had their wisdom teeth extracted get rid of those old medications don't save them for that rainy day you can take them to the police station or we've just gotten some grant funding for some of the pharmacies to get a kiosk to have one there so when people are going to do their drugstore shopping or pick up a new prescription they can get rid of their old ones we also are working with the Vermont Department of Health to supply these mailers to communities which is postage paid people can just cross off the name on their prescription bottle put it in the envelope seal it up and drop it in a mailbox or take it to the post office that is encouraging and so the campaign that the Vermont Department of Health is running is called Vermont's most dangerous leftovers and this is really trying to get the word out that we don't want these old prescriptions sitting around so we can reduce the access and reduce the use along along those lines reducing supply there was a recent report of the Vermont prescription monitoring system Vermont the percent of Vermont population receiving at least one opioid prescription in January of 2016 was 6.9% in two years it's been reduced to four point 9% down 2% in two years that is a profound reduction that's prescribers being educated about the dangers of prescribing opioids for chronic pain really reducing the supply that is a wonderful example that you give what about other partnerships that just find important in the community and the the beauty of prevention from my perspective is that everybody has the opportunity to be a partner in this work so while we have professionals that we partner with very closely with other community organizations and physicians and hospitals like Ann was saying parents but it really is it needs to be an entire community effort we all need to be providing support and offering the same messaging not only to youth but to the community as a whole this isn't just a focus on preventing kids from using or trusting kids and making the healthy choice it's really about changing the dynamic of the community so that the that there's almost that there's not a decision point to be had because because the problem has been contained that makes sense that's changing around what what people think what people believe how they act how they interact how they educate their children and the opportunity for drugs right you just can't control the opportunity you have to control people's motivation also or or impact people's motivation so there's so the organization I work for is community substance abuse prevention coalition which means that we try to engage a variety of sectors around the table to solve a problem essentially and there's coalitions like and also works in this similar model there's coalitions like ours across the state that are doing that work that are bringing together different sectors of the community whether it's education law enforcement businesses sometimes media representatives parents youth to try to say okay what are we gonna do about this community challenge and that model is one that that's been replicated across the country that it really does require a variety of sectors to work together to make community change so you know I would encourage communities to either get involved in your local coalition if your community has one or if they don't to think about how maybe you could start one and the the way that groups like that who have done good work in Vermont work is that they look at what are kind of doing some data analysis what are the problems in the community assessing what are the community needs and then figuring out what are the strategies that we're gonna take to do something about that and that model works really well because it does kind of force all these different sectors to participate and to to reinforce the same messages so the more moving parts moving together in a unified way the more likely the the success is that what you're saying yeah a little bit of that and also that like everyone's kind of involved in sometimes making a large community change requires a lot of different people to be invested essentially so it kind of makes it gets everybody involved in making the changes that are necessary we talk about that as community buy-in right you know get a community buy-in you know if if everybody has a little bit of skin in the game they're that much more invested in making it work skin in the game all hands on deck same thing same idea it's really children in the game you know it's our children that are really really at risk here it's there it's all our children and that to me did you did I interrupt you well they are our children yeah yeah and those children want to grow up and be very autonomous and independent and they kind of don't want any more help from their parents you know which is a natural stage to go through but my message to parents is really to just continue to be the parent even when it's hard it's not your job to be their best friend and those kids they want to go to a party or they want to stay home alone or they want to have friends over and there have to be really clear guidelines and clear rules and then consequences for any kind of behavior that would that that would go on and even for parents to partner with other parents in the community it's hard you know to really put yourself out there and make a phone call or you know become a Facebook friend with some other parent you know of your kids friends but I really encourage them to do that so that you find out what you know my kids said they're going to a party at your house are you gonna be home what are you gonna do is it gonna be supervised what's happening you know and just like when kids are younger you know do you have guns in the house maybe now you have to talk about well what's your policy around alcohol or you know we don't allow our kid to be drinking until they're 21 and we don't want them to be around marijuana right now and I think we had we had touched on that a little bit earlier that part of the reluctance for people to really talk about this is the stigma attached to it it seems to be a shame and you know a shadowy kind of a feeling about talking about substances when when you have a toddler you don't hesitate to tell the toddler the dangers of putting a sharp object in their mouth for something that's a non-edible why do we why do parents hesitate really to talk to their children about substance use because of stigma and hesitation what are we what are we doing what are your groups doing about about stigma about reducing stigma in Vermont so in our community we're we started a parent education program called parent in which is really just it's called parent in Burlington and it's really about helping parents think early about how to prepare and get yourself and your kids ready for the challenges that come later so oftentimes I think what happens for parents is that we we wait until there's a problem to do something about it right like we wait until we see our kids struggling or we wait until there's been a party and our kid comes home drunk and then we figure out what we're gonna do about it and the the parents who've been the most successful or the communities that have been the most successful have learned how to start having those conversations early so that when your kid is presented with that situation they already know what their answer is gonna be they've already thought about it they've already prepared they've already practiced how to say no if if the first time that they experience someone offers them a drink or offers them cannabis or offers them a pill is the first time they thought about it they're more likely to say yes right so so we're really trying to help parents think about even when it feels like your kid is too young I mean I have a almost 11 year old and a 13 year old and and it makes me feel I don't love talking to them about this stuff either because I don't want to take away their innocence right like you feel like you're taking every time you have these conversations you think you feel like you're taking a little bit away of their innocence but but I also want them to be prepared and I don't want them to feel to not know what to do when they encounter situations so so I think the more we can talk about it the better and the more we can provide a community for parents to talk about it the together the better so it's why we created this parent in which is for parents to kind of create their own communities so that they can talk to each other about things and also feel if you start to if you start to create a community where you feel comfortable with each other then you can you're more likely to have those uncomfortable conversations or those challenging conversations where you might have to ask another parent hey I just want to make sure that you are keep you know we're we're legalizing marijuana in the state as of July 1 people will be allowed to have marijuana in their homes so so we're gonna need to go to other parents and say hey I want to make sure do you have marijuana in your home is it locked up you know can my kid get access to it those are uncomfortable conversations we're gonna have to have so if you can create a community where you already feel comfortable with the other parents it's much easier to have those conversations and the beauty of this campaign so we're running the same the same program in our district as well and one of the beauties of this is is these are all local families who are highlighted in the program which really creates that community and we're highlighting families who are doing the right thing who are engaged and I wanted to go back to something that Anne said one of the beautiful things about talking early and often to your kid is that we know well into older adolescents that parents are the number one influence on their students decisions around substances and so even when they're slamming their door and stomping their feet and rolling their eyes and huffing at you they're hearing what you're saying you're not gonna get the feedback from them that's proof they're hearing it right and it's and not only are they hearing it but they're taking it in and it's sinking in and so it is even when you feel like there you're making no headway know that that saying it over and over again is actually you're getting somewhere yeah the younger the kids are the easier it is really you know I mean a 10 and 11 year olds are more open to learning about this and wanting to follow the rules and if you start early then it's not this very difficult you know conversation that you might have with a middle schooler or high school or even college and and you really need to continue to have these conversations right through college and to normalize that yeah seize the moment yeah seize the moment have a conversation at an age appropriate level yeah the conversation may be different for a 10 year old and a 14 year old but go to parent and figure out what's the director what's the best approach and have that close conversations with your children I had them Brendan del pozo the police chief was on my show and he has two young children and he talked about that you talked about being on a hike beautiful hike in Vermont on a beautiful day and kind of debating about whether or not to bring this topic up you know it's a beautiful day what I want to bring this up but he bring he brings it up to normalize it bring it up have the conversation the conversations over continue with the day until the next time that the moment is there in that way it's it's not an unfamiliar taboo stigma topic it's something that we just discussed it's part of part of life and it's not a one-time excuse me it's not a one-time long lecture it's just these little snippets that you want to keep getting in there yeah it's the moment in the car when you hear the local head shop commercial or you're hearing an advertising for a local vape shop and the variety of flavors they have for their e-cigarettes and jewels and so it creates an opportunity those for me as a parent or the time as I'm turning the radio off because I don't want to hear it to say to my 15 year old who do you think that's for do you do you think I'm looking for cotton candy right flavored didn't someone have a jewel do we have yes we do yes and this has been such a problem in all of this schools right now this electronic cigarette vape vaping device which is easily concealable and you know it can it just charges in your laptop it's battery operated I was just going to say it looks like I want to put it in my MacBook so parents don't even know if this is in their kids backpack or if it's in their room they think it's a flash drive and so they don't know and what's really unfortunate is yes just as all of the smoking rates cigarette smoking rates are going down using electronic nicotine systems vaping devices or e-cigarettes is really on the rise and what we found is that most kids don't know that there are nicotine in the that there's nicotine in this which is so harmful to the developing brain and young kids and they also don't know about the dangerous chemicals that are in the flavors I mean there are thousands of different flavors of e-juice that you can put in these and they're really appealing to kids and but those flavors in there were meant maybe for food consumption but never to be ingested or inhaled or heated so yeah you know and I think we talked about that a little bit earlier like the marketing power yeah of the corporations that manufacture these things I mean we've seen that with opioid pharmaceutical pharmaceutical companies developing opioids in the marketing in the 90s in the early 2000s and what it's led to today this is just you know the latest iteration of that these companies some of them are losing so much money because we're being successful with cigarettes so they come up with a product like this that's aggressively marketed to children although it's disguised you know it's the same thing we talked about earlier with the earlier you can get somebody to start the more likely they are to develop an addiction and so companies know that as well they know and they know that that's how they'll make their money right is that the more like the more often people use the more money they make and so there is a there's a business model that that kind of supports getting people to use more often so we as community members and as adults really need to think about how do we delay kids from using the longer we can delay the better the longer we can if we can get someone to not use until after their 21 which is you know really ideally what we do for any substance most likely they will never pick up an addiction right and you know I wanted to add to our earlier conversation for parents is you know talking early and often is really important for your kids but it's also important that if you're if you have any concerns that your kid might have a problem or might have you know might be struggling either with dependence or using more often get help right away the earlier you can intervene the better even if you're not really sure what's going on and you're confused there's a lot of wonderful organizations that help support parents of adolescents and I've never I've never experienced a parent who said I wish I had waited longer to intervene right like they all almost every parent whose child is is going through it a problem with addiction right now said I wish I had intervened earlier I wish I had taken them to treatment earlier so that that piece of like as a parent not wanting to admit that there's a problem we have to let go of and you have to kind of intervene as soon as you're worried I can't even reinforce that strongly enough that the longer a person hesitates the more time the addiction has to take hold right on a neuronal level in the brain and again that that speaks a little to stigma no parent wants to think that their child is using substances no parent wants to admit and that's largely to do with stigma if your parent has mumps or measles or chickenpox or some pneumonia or something you go to the doctor and you get help and it's just matter of course okay we're better with substance use it's a little bit different and that again you know comes to us our responsibilities to reduce that that stigma I think speaking to that I think that you had some information regarding messaging preventive prevention messaging on a universal level do you want to talk about that for a minute well actually so and brought a little information about parent up which is the campaign here in Vermont that parents can access if you go to parent up vt.org parent up vt.org is the website it's a great website that Vermont has for parents that can help you with kind of what are the different supports that help support your kids to make healthy choices but also to identify when your kid might have a problem so there's a portion of the website that says like are you concerned about x y or z and those are for families who are going there because they are a little worried that something might be wrong with their kid and then there's a whole lot of information just about how to create healthy boundaries how to support your kids to make healthy choices how to talk about some of this stuff which is really uncomfortable and and we don't maybe we as parents need to do a little learning ourselves first before we go and have a conversation with our kids so it's really a great website and kind of the more you you can kind of like click in to learn something and then there's usually like another level of learning if you click a little bit more and another level so like the more you want to know the more they'll be for you to know essentially and you can also just get like a little bit if you're feeling like I just want a little bit at a time so about prevention messaging did you have did you want to speak about that a little bit under that universal kind of approach sure well I mean we can talk about so here in Vermont there is the Vermont Department of Health has a number of campaigns that they've been doing for quite a few years around a variety of different prevention messaging and then I think there's hope that will there's some new campaigns in development as well so as part of the governor's commission there's been some support for creating a few new campaigns so that parent up is one of them which is really thinking about we've talked a lot today about tobacco and alcohol and marijuana because that tends to be where kids start so those and when we talk about gateway drugs I don't love that term but those tend to be the three gateway drugs there isn't necessarily one there's kind of three that tend to lead kids towards other use so again the longer we can delay the more likely that kids will never develop those good move on to the next phase other drugs which tend to be the opiates so that is really looking at those really the parent up campaign really focuses on those three things tobacco alcohol marijuana and then there's some campaigns around prescription drug awareness that are there's a few that are targeted at the whole state which is the Vermont's most dangerous leftovers campaign and then there are a few that you'll only see as a Vermont or if if you're in the target audience so there's one that's targeted at young adults which is really about understanding that that these prescriptions are dangerous if not used as approved biomedical professional and and they are really for young adults who may have already tried to use a medication and to to kind of help wean people off and then there's a lot around safe medication disposal and safe use so there's a lot of different things that are going across their state and then there's some that are in development now so I think that probably the Vermont Department of Health is the best place to get information about any of them but there's just so much going on on so many different levels and that to me is just so encouraging just coming at this from from every vantage point every angle with a sustained kind of energy all hands-on deck parents teachers professionals anybody who everybody can contribute to this I think that's one of the things that's most important you know you mentioned gateway drugs in that phrase and when we think of gateway drugs we think of alcohol tobacco and marijuana but it doesn't gateway drugs doesn't really capture the essence of what's going on these are dangerous psychoactive chemicals known to cause addiction alcohol and tobacco or two of the three leading causes of death preventable death on our planet so I mean these these things are are dangerous and I think we have to somehow without seeming like we're trying to frighten our children you know introduce them to some of the research you know some of the facts some of the truth about these chemicals that are normalized you know we use language that that's so inappropriate sometimes recreational use of how can you use something recreationally when you're an adult like we've been alluding to I guess you have the wherewithal and the maturity to make decisions based on rewards and consequences hopefully but kids when they get these messages the take-home is is always kind of not quite you know the reality of the danger it's confusing to kids it really is they're seeing so much on social media yeah and you know that they their perception of harm in risk is so much lower they don't know all the information so I I feel like they need to be getting more information not only in their health class but in psychology and sociology and in their biology and their civics class you know and with their families you know really for every kid to really think of three things that make them feel good that they like doing or that they're good at or they enjoy so that they have something else that is going to give them that lift so they don't need to turn to a mind-altering substance and also so that as a refusal skill you know if somebody says hey let's go do this let's go get highlights that they they can say no let's go shoot some hoops instead you know why don't you come with me yeah or you know where I'll be yeah you know I'm going I'm gonna go do that instead kids need to know what what what fits for them and and basically to engage that same part of the brain yeah with his reward right without having to ingest some kind of psychoactive chemical natural rewards of life or wonderful yeah and after school programs that introduce you know rock climbing or mountain biking or art or you know a lot of other things that really help kids develop other skills we talk about healthy risk-taking yeah creating opportunities for healthy risk that get the same get those endorphins going that give you that natural high and and creating those opportunities and recognizing the need to create those opportunities for kids in our communities we're getting we're getting near the end of the show I guess maybe to include adverse childhood experiences aces toxic stress like the importance of really addressing the quality of life for many of our children do you have any comments on that and maybe some of the programs that are becoming available today in Vermont through legislature to counteract aces and one of the things that we know about adverse childhood experiences are that the trauma and particularly repeated trauma that her happens early in childhood continues to impact our lives well into adulthood and as it you know from from where I sit in a school district what that means for us is making sure that we have supports in place to meet those individual student needs but also that we have the supports in place for the larger student body a lot of the ways to address aces in a student population is creating relationship making sure that there's no student in a school who is not seen and that means are there staff and faculty who not only know their name but are taking the time to really engage with them mentoring programs things like that but really trying to meet the needs of in not only individual students who may be in crisis but recognizing that you're not going to know every child who's experienced trauma in their life it's just not realistic to expect that so so we blank at the entire population with those protective factors that you were talking about earlier that's that's really beautiful and that's very comprehensive that's very encouraging to me we're just about out of time so I wanted to give you each just a brief opportunity to you know send a message out to the general public and you know just say what what you'd like to say to the viewing audience about prevention well everyone can you know be part of this it takes a village movement of really jumping on and helping prevent and and and it you know addiction disorders can happen to anybody and everybody and so I guess I also wanted to let families know families have loved ones there is Narcan available at pharmacies and anybody who has someone in their world or in their family who is using and is vulnerable for an overdose to make sure that they have Narcan in which is very easy to administer yeah I would I mean I there's so many things I would want to say but I would say I would love to see Vermont think about how we can invest in prevention so really long-term sustainable consistent investment in public in prevention we know that one dollar invested in prevention saves up 18 to 20 dollars in future costs related to incarceration and death and all the things that come as a result of substance abuse addiction so it really does behoove us as a state to think about how we invest in prevention and and again you can do that as a at a community level too you can do that at a school district level you can do that as a parent what are you investing early but you know thinking about how we are supporting sustainable prevention efforts in our community and the other people thing I would say is that we are seeing some progress in kids like from the youth behavior survey results feeling like they matter in their community and that is a protective factor kids feeling like their voice matters like they have a difference like people are paying attention to and care about them so as much as we can support those efforts to continue seeing that thank you thank you thank you so much yeah have a couple of seconds left yeah okay so to Mariah's point I am hopeful that the conversations that are currently happening in our state do exactly what Mariah's suggesting and lead to a sustained prevention effort and in my last couple of seconds again the you know knowing that students feel like their voices are heard kids are not a problem to be solved in our community they are an absolute asset in our communities and making sure that we are treating them as such giving them a voice in their schools and in their communities and a place to really belong is is so so important and I'm hopeful that we can move in that direction thank you thank you so much for being here today and and more importantly thank you so much for your your debtor dedication and your tireless like energy in this most important area our children thank you thank you