Episode 26 An Innovative Approach to Connect to Communities Through the Health to Go Program
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[00:00:00] Michael Donovan: Welcome to the Evidence to Impact Podcast, the podcast that brings together academics and their research partners to talk about insights and real world policy solutions in Pennsylvania and beyond. I'm Michael Donovan, the associate Director of the Evidence to Impact Collaborative here at Penn State.

[00:00:18] Michael Donovan: In this episode, we'll be discussing an innovative approach to connect to communities through the Health to Go program. My guests today are Dr. Alice Zhang, family medicine physician researcher in the Penn State Health Department of Family and Community Medicine, and Marcia Goodman-Hinnershitz, director of Planning and Resource Development at the Council on Chemical Abuse. 

[00:00:43] Michael Donovan: Thank you both for being here today. Marcia, could you start us off with just, a bit of an introduction, on yourself and your background? 

[00:00:51] Marcia Hinnershitz: Yes, Marcia Goodman-Hinnershitz, I work with what's referred to as a single county authority for drug and alcohol services in Berks County and we serve a population of about 400,000, making sure that everyone has access to evidence-based prevention, intervention and treatment services.

[00:01:14] Marcia Hinnershitz: And through this we're always looking at innovative approaches to reach those individuals who may not be engaged in public health services need access to drug and alcohol services and so we partner with many organizations through our SOS Berks Opioid Coalitions, and one of those organizations is the Penn State College of Medicine, where we're looking together to see how we can engage people in needed services.

[00:01:43] Michael Donovan: Wonderful. Thank you so much. Welcome and Alice. 

[00:01:48] Alice Zhang: Hi, thanks for having us. My name is Alice Zhang and I am a family medicine physician and researcher at the Penn State College of Medicine. I have been heavily involved in the Health to Go Vending Machine project and a lot of it was sparked by you know, my own clinical practice in being able to take care of patients within the clinic.

[00:02:07] Alice Zhang: But there was always the nagging question of, what about the folks who can't make it to see me in the clinic? How can I better help serve them  and meet their needs? That's kind of how  the part of the impetus for this project came out of. Thank you again. 

[00:02:21] Michael Donovan: Wonderful. So we've teased the Health to Go project here. 

[00:02:25] Michael Donovan: So who would like to give us a little bit of, a rundown? We'll have some photos in our reading notes after the episode, but just you can describe the user experience as you approach your machines. 

[00:02:37] Alice Zhang: So our machine is a vending machine at heart, but we do have a very large touchscreen in front kinda like an oversized iPad  that is the interactive component and the machine is also connected to similar wifi connection, so that allows for a lot of full function. So, at rest, when an individual walks up to a machine, they'll see a kind of like a carousel, public health images and videos playing, speaking to recovery or reducing stigma around substance use, benefits of connecting to treatment and other public health messages as well. Then if they want to explore what the machine has, look at the services we offer they can kind of click and tap around a screen and see what items are available.

[00:03:23] Alice Zhang: See a list of community resources and treatment or anything they might need help with both in a list form and a map form and so they can kind of browse and use that as a community resource. Anyone can do it. If anybody does want to attain an item, they do need to go through what we call a registration process.

[00:03:42] Alice Zhang: And so it's a pretty straightforward process. You create a username, it's a combination of  a color that you choose, an icon, which is either animal themed or nature themed, and then their birth year. After they create their username  we ask them a couple of demographic questions. This is optional that they can skip and not answer if they want, but it does help us get some anonymous information about who's using our machine.

[00:04:07] Alice Zhang: And then once they do that, they've completed a registration process and they can obtain items from the machine. These Naloxone we provide without registration so anybody can grab that  and not have to go through that process to try and make that as easy as possible.

[00:04:22] Michael Donovan: And I'd also love to hear a bit from Marcia, on kind of the genesis of some of, these ideas around using proven technology in innovative ways. 

[00:04:33] Marcia Hinnershitz: Well, it's important to look at how we can best reach people in communities, and vending machines have traditionally been a way that rather than people having to go to the store to locate their product, that the vending machines are located in places either your job locations, recreational centers, places where people go. So we know healthcare products need to be accessible and using the vending machine approach was an innovative way rather than having a health fair display out, we now have a place to dispense products and information 24/7 at locations that are widely accessed by the public.

[00:05:14] Marcia Hinnershitz: I always like to share the story that vending machines aren't new to our community. And in fact, my uncle  started the vending machine business in eastern Pennsylvania back in 1948 after returning from World War II and was looking at a way of getting products such as candy bars. You have to understand, Eastern Pennsylvania is the location of Hershey Foods, so he was looking at a way to do this and actually with his mustering out pay from, World War II, bought a couple vending machines, started to locate them around Lebanon, Hershey, and then expanded all across the eastern part of Pennsylvania. And so when this whole concept was introduced by the Penn State College of Medicine, it really clicked with me, 'cause I saw how successful his business was in reaching a broader population.

[00:06:04] Marcia Hinnershitz: And I thought the same  approach can be used with healthcare products. Fortunately, vending machines have evolved since the really simple machines back in the forties to the fact that they're now  electronic. They have technology embedded in them large iPad, which allows you to access information.

[00:06:23] Marcia Hinnershitz: So it's not the simple vending machine that we were accustomed to, but certainly has the capacity of really reaching a larger audience with really important health information. 

[00:06:35] Michael Donovan: Excellent. I love the family connection as well. Alice, could you give us a rundown of some of the wellness and personal care items and health items that have been included to date.  and what the initial reactions came from the community on this. 

[00:06:51] Alice Zhang: Sure. So initially the idea for the Vending Machines came during or I guess the impetus during the COVID-19 pandemic when we started to experience these dramatic increases in fatal overdoses that were, that are only now starting to subside.

[00:07:07] Alice Zhang: So initially the thought was, all right, well, how do we get Naloxone out into the community? As some folks may know, Naloxone is a key lifesaving medication to reverse opiate overdoses. And so that became the driving factor when we were planning for the vetting machines, but unfortunately there's a lot of stigma around Naloxone.

[00:07:30] Alice Zhang: So we wanted to pair the vending machine with other items beyond harm reduction items, and also recognizing that folks have many co-occurring needs as well. So that's why in our vending machines, we have a whole host of health harm reduction items and also basic needs items. So we have Naloxone in there.

[00:07:49] Alice Zhang: Naloxone both by itself and within the kit with a CPR Face Shield. We have drug checking strips for Xylazine and Fentanyl, medication disposal bags as well. We also have a lot of basic need items like wound care kits, menstrual kits, hygiene kits  to help with the basic needs. And we also have a whole host of other sexual health and general health items. 

[00:08:13] Alice Zhang: So we have pregnancy tests, HIV, self tests, condoms, and all seasonal items as well. So during the cold and flu season, we have what we call cold and flu kits, which help with the symptomatic management when you're feeling kind of ill. And then in the summertime we're hoping to put in some hydration packs as well.

[00:08:31] Alice Zhang: So there's that flexible part where we try to adapt to the changing needs. 

[00:08:38] Michael Donovan: Very robust and how has  overall community engagement been? Has it been a large pool of people? It's an interesting novel concept, so I wonder if people have been aware of it and how it's been taken up.

[00:08:52] Alice Zhang: I definitely think the response from the community has been far greater than what we initially expected. So much so that we had to kind of adjust how we operationalized the vetting machines so that we wouldn't run outta supplies and try to keep it stocked for folks. So I think that was the initial response for me.

[00:09:09] Alice Zhang: I was like, oh my goodness, people are really really coming to the machine and really making use of it, which is good, and unfortunately probably speaks to some of the needs in the community as well. 

[00:09:20] Michael Donovan: Absolutely, and maybe you both could speak to how the collaboration between both, the broader Penn State community and the Council on Chemical Abuse came about.

[00:09:30] Michael Donovan: You know, this is a one iteration of longstanding partnership as I understand. Marcia, any thoughts, on kind of the historical connectivity between the two? 

[00:09:40] Marcia Hinnershitz: I think first of all, it was very important that we all serve together on a coalition whose goal is to reduce overdose deaths in Berks County.

[00:09:51] Marcia Hinnershitz: So that's where the collaboration started from. And looking at the Penn State College of Medicine being very invested in researching out what approaches work, doing a lot of outreach, through participation in conferences and such, they were able to bring the idea of the health to go vending machine to the coalition as it was introduced to the coalition members and there was a support from it.

[00:10:14] Marcia Hinnershitz: And you have to understand coalition members are various folks, professionals in our community, including law enforcement, medical professional, drug and alcohol counselors  community members, persons in long-term recovery, all had a vested interest in making this work as they saw it happening. And because of that, we were able to identify a partner organization where we were gonna locate the machine in Redding, and that was the YMCA. And if you look at the YMCA, you would never think, well, this is where we also wanna dispense items like Naloxone drug checking  materials. But it indeed worked out perfectly because the YMCA also houses persons in long-term recovery or has a lot of different social services.

[00:11:01] Marcia Hinnershitz: So it was a perfect fit, by having it in that location, we were able to then address the stigma. So it was located where a bank of vending machines were, so if you have those products next to where you're getting your iced tea, your candies, your sodas, it really made it look as a normative type of part of the  community.

[00:11:24] Michael Donovan: I had love to unpack that stigma piece a little bit. And have you felt that has been, in your experience, or in broadly in the literature understood to be across certain demographic  groups worsened, or I'm interested in thinking about, you know, this is such a wonderful approach of allowing those who may be in need to be able to not have to interact with a human being. I mean, there's an opportunity here to be able to de-stigmatize in that respect to not have to explain, or come up with a rationale. Have you felt in different ways that has been more relevant to adolescents? 

[00:12:01] Marcia Hinnershitz: I think we know that there are certain folks that feel they're being judged if they have a problem, and so they do not necessarily wanna come up to an agency, even go to a stand at a health fair and get information because they're afraid that they're being judged by their request, but the vending machine, everything's anonymous.

[00:12:25] Marcia Hinnershitz: So they don't know that any, they're not interacting with an individual, but they're still getting the same resources that an agency can provide as far as materials that will help them address some health issues.

[00:12:47] Alice Zhang: Go ahead, Marcia. 

[00:12:48] Marcia Hinnershitz: I believe, Alice, we received feedback from some of the machine that stated, that they felt more comfortable accessing something on an anonymous basis. 

[00:12:58] Alice Zhang: Certainly, yeah. So one of the neat features of our vending machine is that we're able to ask survey questions through the touchscreen and get some anonymous and also real time feedback. And we've also paired that with some qualitative interviews as well. So we've had a really high response of people saying that they felt like the vending machine was reducing stigma around naloxone or around substance use and that they weren't feeling judged when using a machine. And similarly with the interviews, people echo how it's discreet, nobody knows like what you're getting. All you're doing is kind of tapping along the screen, getting the items. Nobody's judging you for what you decide to get from the machine and so there's that somewhat comfort level of being able to protect their health and prevent things  without feeling that sense of judgment from others.

[00:13:50] Michael Donovan: That's amazing, if we could only think about how to scale this as a concept to that end I'm really thinking about how this is funded, right? And, how this is this particular opportunity in what way, maybe Alice, you could give a little understanding, of what kind of grant mechanisms were in place to support this over time.

[00:14:10] Michael Donovan: I know that it's also been quite a few different  physician researchers involved through over time as well. To think about how do we get this to be deployed, in other settings? 

[00:14:22] Alice Zhang: It was certainly a tremendous undertaking and a very diverse, big group of team members who helped to make this possible.

[00:14:31] Alice Zhang: One of the challenges we experienced early on was while we were trying to find  funding sources, a lot of folks were drawn to the concept of having a health vending machine, but wanted to see the evidence or impact. And of course, you know, it was kinda a chicken and egg situation or like, well, we need some funding too in order to get these vending machines in place.

[00:14:51] Alice Zhang: So we initially were able to get some internal funding from Penn State to help launch this program and we have two vending machines currently in place. One in Harrisburg, Pennsylvania  which is outside an emergency department and then a second in Reading, As mentioned inside the YMCA. So with some internal funding with Penn State, we were able to get this started and as well with some foundational funding from UPMC, where the Harrisburg machine  was placed  UPMC Foundation, And so that helped to jumpstart the project, get the machines launched and then from there we have multiple sources of funding, both from the NIH and NIDA the (National Institute of Drug Abuse), as well as the opioid remediation funds from the county.

[00:15:43] Michael Donovan: Do you foresee any increase in  potentially the remediation funds, as time has moved on and the  allocation of those funds have been a little more clear, but at the same time  existing, in a period of time where NIDA funds may be more at risk. So, what are your kind of projections reading the crystal ball, for the future here?

[00:16:04] Alice Zhang: Well, I certainly wish I had a crystal ball so I could look into the future because funding currently is short term and somewhat volatile, and funding plays a huge role in what we're able to do with these machines. The response from the community so far has been very overwhelmingly positive about these machines, and we're adding two more machines in the next two months, so we're growing our network of machines within central Pennsylvania.

[00:16:32] Alice Zhang: But the beauty of these funding machines is that it touches upon so many different aspects of health, including and beyond harm reduction. And so there is that potential for a greater impact. If we had more funding, especially more stable long-term funding, we would be able to build out a network of these health vending machines and we could potentially have a greater impact on a lot of health outcomes.

[00:16:58] Alice Zhang: We could potentially reduce unnecessary emergency room visits, reduce healthcare costs,, get people connected to care and treatment, and also more importantly, save lives with getting more naloxone out into the community. 

[00:16:57] Michael Donovan: I realize that as we think about opportunities for scaling up and sustainability and growth, in different localities. And also, I really appreciate your points, Marcia, on the value of unique locations outside of emergency departments, for example to be  co-located with those who may need the items at the most, maybe is there any numbers we could attach to the usage? I wonder if you had anything on top of mind and in terms of how these have been used and maybe any differential usage between the, emergency department in Harrisburg versus the YMCA. I don't know if you have anything top of mind. 

[00:17:35] Marcia Hinnershitz: I can speak to the information regarding the Reading machine, and I know Alice can add regarding the Harrisburg machine.

[00:17:42] Marcia Hinnershitz: So the machine first became operational in March of 2024, so through March, 2024 to October, 2025, over 6,800 items have been dispensed, and of those items, 2200 of them were related to harm reduction such as the naloxone, the drug checking strips, wound care kits, and also medication disposal bags.

[00:18:10] Marcia Hinnershitz: Another 3000 of the items were health and wellness related, including hygiene kits, HIV testing kits. The cold and flu kits and then the other 1900 were sexual health related items such as menstrual kits, safer sex kits and such. So, we really had a wide variety of products that were dispensed, and we saw that individuals were oftentimes making use of more than one product, depending on what their health needs might be.

[00:18:42] Alice Zhang: In regard to access of the two different machines. So the location of them has, we believe greatly influenced how they've been used in access. So for example, the Harrisburg machine, it's in a covered courtyard outside a very busy emergency department, and so we're seeing a lot more what we call after hours usage of that machine.

[00:19:04] Alice Zhang: So it's being accessed from 6:00 PM all the way up until three or 4:00 AM which also coincide sometimes with the emergency department, busy hours. But that is also when a lot of businesses and other services are closed, so that machine is helping to fill a gap in need. When most people are, yeah, most of the services are closed.

[00:19:25] Alice Zhang: So that's one difference that we are seeing. The Reading Machine, while it is accessible after hours after a certain point, just for safety reasons, you do have to ring the doorbell to be let into the lobby of the YMCA. And so we aren't seeing as much after hours access with the Ready machine compared to the Harrisburg one, but that's also a reflection of the location.

[00:19:49] Michael Donovan: Yeah. And that plays such an integral component to the stigma conversation I'd imagine as well. I wonder if the funding and sustainability question was solved tomorrow, do you have  targets for growth and expansion? And how would this scale? Those are some of the questions that would be really exciting to be able to tackle next. 

[00:20:11] Marcia Hinnershitz: Well, I think what's important about our first rollout of the machines is we picked areas where we saw the highest health risk related to overdoses. So they were strategically placed, so we would, again, look at where we're seeing  other high areas of risk and look at who our partners might be and locate the machines in those areas.

[00:20:34] Marcia Hinnershitz: So I think it's very important when you're planning out to make sure you're reaching the greatest population that you can and be able to look at also getting feedback from the people who  reside in those areas to see whether they would feel this would be helpful. To be, now that we have documented use of the machine, we can go back to  in other areas and be able to talk about what we learned and how they would see it fit into their community.

[00:21:05] Alice Zhang: And beyond the location, in terms of other things we would like to do with the vending machine I feel like we're really just at the tip of the iceberg in terms of what we're able to do. And, you know, if all questions of funding and sustainability were answered tomorrow, which would be great, there are so many small and large side projects that we've been thinking about that it would be great to incorporate.

[00:21:26] Alice Zhang: So, one of the actual products that we're going to be launching soon would be including diagnostic and screening tests in there. So while we have the HIV self test in place, we're hoping to expand and include other sexually transmitted diseases like Gonorrhea, chlamydia, Hepatitis C, have those tests in place so that folks can get themselves tested and then hopefully get connected to treatment as well.

[00:21:52] Alice Zhang: And then similarly too, there's a lot of other potential self tests, like self swabs that people can do at home for colon cancer screening and also cervical cancer screening and other cancer screenings that we're open to corporate as well. So, there's that realm of opportunity and also trying to enhance how we connect people to care and how we connect them to services and navigate the whole landscape because there's so many opportunities and resources available, but also the landscape is always changing based on funding or services being available and whatnot.

[00:22:26] Alice Zhang: So we wanna try to help folks try to get the help that they need and understand what the landscape looks like. 

[00:22:35] Michael Donovan: This pilot data, certainly to me indicates unmet needs in the communities that you're serving, right? And also the opportunity here to meet your folks where they are.

[00:22:47] Michael Donovan: I think that's a really important component that Marcia was pointing at as well. I wonder as well how this has been broadly received in your own professional networks and personal networks. I know that you've, together been on a couple conference presentations and things and are there similar concepts that you understand to be deployed in other parts of the US?

[00:23:06] Michael Donovan: The bigger question here is around harm reduction and the, how that can be a dicey topic in many circles, and this is very much a light duty version of that, but that's something to be thoughtful of. So I wonder in your communications at various conferences and opportunities to discuss this program your reception and then if there's opportunities for growth beyond the Commonwealth eventually, or consultation with groups that might wanna do that. 

[00:23:34] Marcia Hinnershitz: Well, I think it's important to note that we were partnering with an organization located in Canada. The producers of the machine technology, smart one, and they in fact have a network across the country that has vending machines, I think most predominantly in California. So that type of vending machine that technology is, available. What I've noticed  as far as feedback goes, people keep wanting to shift back to the more traditional machine that just dispenses a product rather than the information and the interactive capacity. And I feel that the interactive capacity is such an asset that we should never try to sell ourselves short, that it's okay if you wanna dispense the product so solely, but you really need to be able to push for being able to provide that full access to services that the Health to Go machine does. 

[00:24:29] Alice Zhang: And I would say that we are part of an evolving landscape of, vending machines being placed throughout the country and even the world as well of trying to make these items available readily and easily for the public. So, there are, when we go to conferences and whatnot, we always run into folks saying, oh, we have a vending machine located here and there. And it's kind of always fun to hear about other people who have put their own vending machines in place, and so we're kind of like, yeah, there's a large and growing network of these throughout the country and everyone has their own difference, spin, or twist on how they conceptualize or able to deliver these items. And I think that reflects the community needs and what best suits their community as well. 

[00:25:15] Michael Donovan: I wonder if there's some interesting innovation that could be offered from their sustainability approaches as well.

[00:25:22] Michael Donovan: Whether this is typically funded under grant mechanisms or if it's pillar of budget lines in health systems to some extent, I wonder how that has been how that's differentiated, but obviously that's a very complex network of decisions, and a complex world there, but there probably are some interesting lessons to learn from each other.

[00:25:44] Marcia Hinnershitz: Well, I think what's important to note is that you always, to sustain a project, need to have multiple funding streams. And so this is a good example of that because we talk about the machine itself, but the other thing is the cost of the products that are free of charge to the public. We need to source out where we can get those products, what they cost, how to get them at the most reasonable price.

[00:26:07] Marcia Hinnershitz: Fortunately in Pennsylvania we have access at no cost to Naloxone, so that we can put those on the machines at no cost and some other harm reduction products, we hope that will continue, but we need to continue to patchwork together, and I think that's where the partnerships are so key, how we are able to pull together our different resources to be able to sustain the machine.

[00:26:37] Michael Donovan: Absolutely. I think, that's core to it, braiding funding for multiple sources to be resilient against threat and issues of sustainment, for sure. 

[00:26:46] Michael Donovan: And then also, one thing I was interesting about, the survey deployment. As a result of usage is that compulsory?

[00:26:54] Michael Donovan: What is your uptake? That would be interesting and how the balance of being burdensome, but also robust. That's always a challenge if you know some experimentation on that how much can you really ask someone, to dedicate to a survey when, they're just needing something, maybe even very quickly. 

[00:27:13] Michael Donovan: Let's touch on that. 

[00:27:14] Alice Zhang: Once they get their item, sometimes we do ask them additional survey questions through the machine.

[00:27:19] Alice Zhang: We try to keep this very minimal understanding that people don't wanna be bombarded by questions, but it is also helpful for us to get a better sense of, like I said, who's using the machine, get feedback from them on what's working, what's not working, and kind of get some additional information about their behaviors and how it's all the folks that we're reaching as well. 

[00:27:42] Marcia Hinnershitz: Well, I think what's fascinating by the machine is that people may not understand what it is when they first approach it until they start touching the screen.

[00:27:52] Marcia Hinnershitz: What I've seen happen in the YMCA is that people that reside there, that have used the machine are introducing it to other people in the community. So I saw the other day just a self instruction where they're showing you have to answer these survey questions. You don't have to answer them if you don't want to. 

[00:28:07] Marcia Hinnershitz: And I watched as the an individual was helping their peer navigate through it. So it's by word of mouth, that way that people can see it's very simple to use. People are becoming more familiar with this type of technology, and of course the reward is being able to get an item at the end so that people are able to get that. 

[00:28:25] Marcia Hinnershitz: 'Oh, I got something that was helpful for me. I'm gonna go back and use it again'. One of the things we found is we're able to track how much time people spend at the machine. Normally, if you get an item dispensed, it's only gonna be less than a minute. We're finding people are using the machine five or more minutes, so they're spending some time interacting with it.

[00:28:47] Michael Donovan: You bring up a good point about, the promotion. What kind of efforts have been done within your organizations or external to it to get the word out? It sounds like word of mouth, is an excellent validator from a trusted source. Are there any efforts that you've done? 

[00:29:02] Marcia Hinnershitz: Well, we've been publishing articles in different journals, where they reach a broader community. We also have signage promotional ads in different publications, so the people, I think, are becoming familiar and we continue to talk about it wherever we have an opportunity, whether it be a radio talk show, whether it be any kind of local magazine or journal.

[00:29:26] Marcia Hinnershitz: We're using every opportunity we can to get the message out. 

[00:29:31] Alice Zhang: I think one of the feedback we received from folks in particular with the Reading machine, was that many knew that there was a machine located inside of the YMCA. So one of the efforts that we did was we created basically a sandwich board outside of the YMCA, just letting people know that resource was available.

[00:29:49] Alice Zhang: Because unless you walk into the YMCA, you probably aren't aware of that resource inside of there, so that's something we took directly from their feedback and others feedback and corporate that to promote the machine. 

[00:30:04] Michael Donovan: Well hopefully our modality here in podcast form can be helpful in getting the word out, both to those who may want to partake and also support it as an opportunity for growth and sustainability in future.

[00:30:18] Marcia Hinnershitz: One point that we didn't mention is the fact that our machines are bilingual with the predominant populations being English and Spanish speaking. We make sure that all the resources are available in Spanish, and I think that's very helpful to be burdening our reach. 

[00:30:37] Michael Donovan: Extremely, That's a great point to make.

[00:30:44] Alice Zhang: Yeah. And I would say too that, speaking to its impact, we're obviously still looking into and doing some analysis about how it's influenced some public health outcomes within the community as well, but just speaking with folks who have used the machine, we've gotten a lot of positive feedback on how it's improved their personal health, quality of life, especially in these times when it can be challenging to afford even the basic items. One person had mentioned in the interview that we were doing with them that they would take better care of themself, and it's really just the small things too of just getting stuff they need to shower to get dressed to feel comfortable, and that has cascading impact on the rest of their health, that they're now able to, or feeling motivated to do things for themselves, for their health that they've been putting off. Just because of these small things that we're able to provide through the machine, and so that's was really heartening for us to hear that even these small things can have a big impact on somebody's life and their health. 

[00:31:49] Michael Donovan: Absolutely, and the combination of qualitative narrative to the kind of usage statistics can really humanize and understand the real impact of this work. That's excellent. Well, with that, I will bring our episode to a close. Thank you both very much for being here with me today. 

[00:32:14] Michael Donovan: Again, we have Dr. Alice Zhang, family Medicine physician researcher in Penn State Health Department of Family and Community Medicine, and Marcia Goodman-Hinnershitz, director of Planning and Resource Development at the Council on Chemical Abuse. Thank you both so much for your time today.

[00:32:36] Alice Zhang: Thank you. Thank you for having us.