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[00:00:03] Colby D'Onofrio: Welcome to Stocking the Pantry, a CalFresh healthy living podcast from Leah's Pantry. We'd like to acknowledge our funder, the CalFresh Healthy Living program, an equal-opportunity employer and provider. On this show, we discuss any and all things community nutrition, food equity, and nutrition security. This is a space for thought leaders to share success stories and strategies for equity-centered and resilience-building initiatives. We hope to foster collaboration and community, as well as leverage strengths among listeners, guests, and hosts as we share ideas and dreams of building a more equitable future where everyone has access to healthful, nourishing food. Hello, and welcome to Stocking the pantry. I'm Colby.
[00:00:56] Tee Atwell: I'm Tee. We are your hosts today.
[00:00:59] Colby: Today we are connecting with Michelle Frye-Spray, who has over 25 years of experience working in substance use prevention. You may remember an earlier episode we did about substance use recovery with Dr. Annie Lindsay. In that episode, we discussed the nuances of working with women in recovery settings, the stigma associated with substance use disorder, and the overlap between nutrition security and recovery. If you haven't had a chance to listen to it yet, definitely go back to Episode 2 of our current season for a refresher.
[00:01:39] Tee: In today's episode, we want to continue that conversation, but this time with a focus on prevention efforts and the impact that nutrition, community, and trauma-informed principles have on substance use prevention. Some of us on the Leah's Pantry team had the privilege of listening to Michelle's presentation at the Food, Mood, and Substance Use symposium hosted by Leah's Pantry and the Center for the Application of Substance Abuse Technologies, CASAT. If you're interested in learning more about this symposium, you can check out the show notes for links to the graphic recordings of each presentation.
[00:02:18] Colby: The latest data from the National Survey on Drug Use and Health, provided by the Substance Abuse and Mental Health Services Administration, showed us that 16.5% of people 12 years and older in the US met criteria for having a substance use disorder in 2021. That's over 46 million people, but in that same year, unfortunately, 94% of those people did not receive any treatment.
These statistics are not just numbers. These are people that we live, grow, and work with in our communities. They are our friends, our family members, our colleagues. Most of us know someone, maybe even personally, who has struggled with substance use disorder. The conversation about substance use is often centered around recovery and treatment, but prevention efforts are vital.
[00:03:16] Tee: Yes, and prevention is at the cornerstone of trauma-informed nutrition security and SNAP-Ed implementation. We often seek to prevent noncommunicable or chronic illness through education, food security efforts, and PSE or policy systems and environmental interventions. More specifically, the work of SNAP-Ed focuses on primarily prevention or preventing illness from occurring in the first place. This same idea can be applied when it comes to prevention within substance misuse or overuse.
[00:03:51] Colby: At the symposium, Michelle spoke to the importance of community for effective substance use prevention. Community provides us with a sense of belonging, support, identity, and connection, and it is especially important for those who have experienced trauma. A strong social network, one that focuses on safe neighborhoods, social connectedness, and health-promoting infrastructure can help alleviate the effects of adverse community events and promote prevention efforts. Scottish writer Johann Hari put it perfectly in his 2015 TED Talk, "The opposite of addiction is connection."
[00:04:36] Tee: Love that quote. Without further ado, we'd like to introduce our guest, Michelle Frye-Spray. Michelle, we're so happy to have you here today.
[00:04:48] Michelle Frye-Spray: Thank you so much, Tee, and thank you, Colby. I really appreciate the wonderful introduction to your podcast and today's episode. Being able to be with you and talk about this connection between SNAP-Ed and substance misuse prevention. Great to be here.
[00:05:06] Tee: Great to have you. We're very excited to hear more, and I know the listeners are too. Please, if you could just introduce yourself, Michelle, and really just tell us what drew you to substance use prevention.
[00:05:20] Michelle: When I actually was introduced to the substance use prevention, it really wasn't a field. It was brand new. This was about 30 years ago in 1990. There had been an incident in my family and my life that was traumatic. It was the homicide of my father. That happened right as I was coming out of the university and at a transition in my life. I had gotten a degree in art. Within about six months of that occurring, I moved to South Dakota. Of course, being out of art school, I'm like, "Okay, what am I going to really do with my career now?"
I was looking for work, and I came across an ad in the newspaper at the time, and it was for a prevention assistant. I'm like, "What the heck is that? What is a prevention assistant?" I actually went to the interview, and in that interview it was kismet. The person that was doing the interview really turned out to be my mentor. Long story short, he gave me the job. I started to learn about the science of prevention and what it actually means. At that point in time, there were a lot of different disciplines coming together to form the science of prevention. That is what began to engage me, the science of risk and protective factors.
The work of Richard Hawkins and Catalano out of the University of Washington started to come into the peer-reviewed research, and community started looking at what aspects of community life, family life, relationships create protection or create risk, and how does the research demonstrate this. I got interested in this idea of the connection to food, mood, and substance use when I was invited to be a part of the symposium.
I was looking back at the surgeon general's report that came out in 2023 on this epidemic of loneliness and the research that's available to us now on the power of human connection. Vivek Murthy, he says, "We're called to build a movement to mend the social fabric of our nation. It will require re-imagining the structures, policies, and programs that shape a community to best support the development of healthy relationships."
That allowed me to really think about the role of connection and how it plays a vital thread in our work across sectors and that we are about being the menders. Really, this brought to me this idea that anyone who is in the helping profession, doing the work that our SNAP-Ed folks are doing, people who are in prevention, that we're really the menders and tenders of community health.
The work of prevention has gone deeper and deeper into my life as a professional as well as the science and thinking about how do we apply the science in prevention and really with a deep understanding of community and the various cultures and diverse groups that we get to work with.
[00:08:57] Colby: Once you start understanding the importance of connection and community, it follows you everywhere. It's impossible not to see the adverse effects from not having community in our world and things start to make sense. I know, at least, for me, in the last year or two, after having been at Leah's Pantry and understanding the importance of protective factors and how trauma and adversity can really create challenges for us in our lives, but I feel like my world just cleared.
It was like, "Oh my goodness. So many of these challenges that we experience in our lives are because of a lack of connection." Then it isolates us further, and then we have less connection. Now we're at this point, especially in substance misuse, where we've never been in this territory before, and it's really scary. It starts to make sense when you realize how disconnected we are. Thank you for that background. What a time to dive into work in connection and protective factors for you after experiencing such a traumatic event.
Michelle, you hold many roles now, including you're the senior manager at the Center for the Application of Substance Abuse Technology, also called CASAT for short, along with working as a co-director for the Northwest and Pacific Southwest Prevention Technology Transfer Center. Can you tell us a bit about what your work looks like within these various roles and settings?
[00:10:31] Michelle: I get to do a lot of collaboration across multiple formal and informal leaders, from people at the community level who come to us and are seeking services to people that are at the state level in public health departments or behavioral health divisions, local level community health organizations. It's exciting work and all focused around offering training and technical assistance for people who are doing prevention work, also allied prevention services, people that are connected to prevention in some way, such as SNAP-Ed, community health workers.
Our services are free. We create a work plan of how to get the science of prevention to the people doing the work and how can we make it affordable and the science digestible so that they can apply it in their real-world setting and make it as culturally appropriate in their world for their communities and their clients because what we know is that we can have as many evidence-based interventions that the science demonstrates, bring it to people, but if it doesn't resonate and isn't practical for their communities, then it's not going to be effective. Prevention has to be a proactive process, engaging communities in participation for making decisions about what is in their best interest.
[00:12:14] Tee: How powerful that is. I really appreciate you highlighting the empowerment that comes with co-collaboration within multi-sector dimensions and being able to tap into the community at its core so you're delivering what is needed from their perspective and needs. Thank you for sharing that. At the recent Food, Mood & Substance Use Symposium, you actually spoke about the power of community connection and resilience in effective prevention efforts. What impact does the community have on substance use prevention? How do you center the community's lived experiences with creating and implementing programs?
[00:12:56] Michelle: One of my favorite definitions of prevention is by one of the early researchers in prevention, William Lofquist. It's that prevention is an active process of creating conditions or personal attributes that promote the well-being of people. Community building, community ownership, it's vital to this process because we know that community changes. Culture is not static.
It's this active iterative process of bringing people together to have conversations to center their lived experience as a community around this idea of prevention and helping people to move upstream because so many of our conversations are reactive and about what are we going to do to help people get the support that they need, the treatment they need. All of those conversations are vital.
However, changing the conversations to move further upstream to think about what are the conditions that create vitality, that create health, that help us to prevent problems before they occur. What are the policies? What are the structures that we need to create? Helping communities center their vision first is, I think, vitally important. What does that look like for them? What does success look like for them?
As prevention practitioners, one of the things that's really important is getting a sense of the history of a community before we go in if we're outsiders because a lot of the work that I do as a training and technical assistance provider is either helping to broker a consultant, someone that has a shared experience with that community that I may not have so that I may not be the person that's always going in to work with a group. Having a sense of what this community, what they're telling us they need and want, and being able to step back, having listened to them and gained some level of understanding of their history, the power dynamics that are in that community and what it might be most helpful to help them build their prevention infrastructures.
[00:15:33] Colby: What you just described, Michelle, goes against what many of us
in the US are taught to believe about substance use prevention. Many of us are familiar with programs that teach us to be afraid of drugs and stigmatize those who use them. Even going so far as to criminally punish people for using drugs. Overdose rates, unfortunately, are at an all-time high in the US. More than doubling between just 2015 and 2022. Why is this method of instilling fear, shame, stigma, and punishment not an effective treatment nor prevention model?
[00:16:17] Michelle: That is such an important question that we need to be asking ourselves, because as you said, Colby, so many of our past structures, policies have been really punitive and some of them continue to be punitive for people who have substance use disorders. We know that people with substance use disorders have a brain disorder. It's good that many people are starting to understand this.
I'm from Appalachia. I grew up there. When the opioid epidemic came out of the culture of Appalachia and what we know now about big pharma and the availability of opioids that was given freely to people in Appalachia, people who were in pain because they were working multiple jobs or in the coal mines, all of those layers of availability of substances created the conditions for people to use easily.
People were also using because they were given the substances or medications by the primary care doctors. If we're thinking about blaming people for an opioid use disorder, a substance use disorder, we're very narrowly blaming an individual rather than the conditions that created that use. We know that people are using from a variety of purposes. We know that substance use is a purpose-driven behavior.
People are attempting to become connected to something. They're either looking to get out of pain. They are looking to feel connected to their peers. Creating stigma on top of that reduces people's ability to seek help. If you think about a rural frontier community, it's already difficult to go into a mental health provider, to seek treatment because of those close-knit relationships that are there if stigma is apparent.
However, if you turn and look at the close-knit community that might be available in a rural community as a protective factor where there's no stigma, then you have people who are reinforcing and saying, "It's okay to seek help." We need to have people who are the catalyst of health and treatment-seeking, so helping people who are seeking treatment.
One of the challenges when we're talking about fear tactics in prevention is that there have been many efforts to just say no and telling young people that this is your brain. Even just going in and sharing information about drugs. These efforts are very well intentioned. However, we know that they can have iatrogenic effects. That means that they can have the opposite effect than what we want. That's where our training becomes really important with the prevention field because this is an ongoing challenge that we've identified.
Some of the challenges are due to the workforce turnover. New people coming in, and they don't know what the science of prevention is. There may be some disconnect there with the science of prevention. Really helping people to understand that just information dissemination does not create behavior change, nor does a fear-based tactic, particularly with youth, because of the brain architecture. We know that the frontal cortex doesn't evolve fully until the age of 25.
Much of the scare tactic messages that we use with young people can be reinforcing, especially if they're high sensation-seeking and risk-taking. Some of those messages might support them to go out and use. There's this reinforcing attitude that it won't happen to me. When we're working with young people we need to be very mindful and research-driven about the messages that we are providing. We need to be testing those messages using evidence-based interventions and strategies so that we are really increasing the likelihood of effectiveness and reducing the likelihood of doing harm.
[00:21:12] Tee: With that fear-based messaging, it's really trying to scare people into never trying substances, but young people are curious that risk-to-reward aspect of the prefrontal cortex is very different in a young person than an adult with a fully developed brain. I feel like when young people do try substances, they're like, "Oh, it's not nearly as scary or as nearly as bad as I was told it was."
All the information that they received around that fear-based tactic, even if some of it was true and was helpful, they don't believe any of it anymore. All the information just goes out the window because they are having an experience that's very different than what they were told their experience would be. Any information is just completely gone. I think if we meet young people where they're at and we treat them a little more with empowerment, and we talk to them about, "Hey, this is the reality of it. It's going to be a little different for everyone. We all have different risk factors."
If we're a little more honest about it, instead of trying to scare people or almost trick young people into just say no, it creates a much more level playing field and a deeper understanding and hopefully encourages people to take control over their own life.
[00:22:28] Michelle: I agree. When we're thinking about how to best intervene with young people and what programs or interventions are going to work, we need to be data-driven. We need to understand what the underlying conditions are that are promoting that use, that are increasing the likelihood of people using. Why are they using substances? What are the risk factors in their lives that are prevalent? What are the protective factors that are prevalent or that need to be increased? The only way we can do that really is through collecting good data.
[00:23:11] Tee: Yes. The data is so important. What I'm hearing is that you're saying let's lead with curiosity, let's lead with that why, so that we can come to a nuanced understanding. I want to take this back to what you spoke about earlier about your community that you grew up in, in Appalachia and how that community had its own unique challenges. When we're thinking about prevention, how do we build programs, how do we offer services that really take into account the needs of individual communities?
[00:23:44] Michelle: One of the frameworks that we have used for many years as a training and technical assistance tool is SAMHSA's Strategic Prevention Framework. It's a five-step planning process. It's a public health framework that also centers cultural competency and sustainability in the center of its work. First, teaching communities how to collect data or states or tribes or jurisdictions. I work in the Pacific Southwest with people who are training the behavioral health workforce in the six Pacific jurisdictions.
The conditions there look very different than in LA. Being able to take a framework that communities can apply to their culture, their context is really vital. We found that this framework has some fidelity. It brings outcomes that you want in terms of public health. We train people in this five-step process that begins with assessment, looking at capacity building, how do you take the data that you're collecting, that you've collected, and make decisions around it to implement interventions that are a good match for the specific priorities that come up in a community.
Let's say, in some communities that retail availability of substances like alcohol might be driving a problem. Young people might be going in and getting alcohol or cannabis because people are not trained. They're not carting them. That might be one level of availability and one type of retail availability. However, in another community, there may not be, like many of the reservation communities we work with, there's not the retail availability.
It may be more of social access. They may be getting substances through their friends, through family. Understanding how and where young people are getting substances is one way to start identifying the very proximal issues that are driving a problem. Communities also want to need to start thinking about what might be those more distal factors, like social determinants of health, that are also contributing to substance misuse.
With many funding sources, there's a challenge because communities may only have them for five years, this funding for three to five years, and they need to get to outcomes. Sometimes they're only selecting what those most proximal factors are, the closest, like the risk factors, are that they can really change in those three to five years. Historically, they haven't invested prevention efforts or collaborated to look at the determinants of health and impacting those social determinants of health.
More recently, there's been greater focus on how do you do both? How do you help communities select some of these factors that are more closer to the problem, but then going really deep and looking at, is this issue related to trauma, to cultural change? Is it related to lack of access to vital health and social factors? Helping communities identify partners who may be able to work with them and support going to other people's table to support their work related to impacting these social determinants of health is one way prevention practitioners have found some solutions.
SNAP-Ed, how do we work better with people who are working around food and nutrition security? That's one of the key areas in our work in prevention that's key. How do we work with people who are beginning to look at housing and reducing populations who are unhoused?
[00:28:15] Tee: Yes, you said it, Michelle. Bringing up the fact that this is a multilayer situation. This doesn't exist in a silo. It is community-specific and has a lot to do with the culture within what we reside in. The importance of having a data-driven approach can really be the make or break for some powerful and influential programming. In my previous position, I used to work in nutrition education as well as substance use prevention. Best believe, the SAMHSA's Strategic Prevention Framework was at our core. It was so easy to actually implement and give us the structure that really propelled us in a matter of time where we didn't have to create the wheel.
We also know that it's data-driven, and it actually set us up for success, especially even within our coalition work. Being able to apply this to all levels, I do want to highlight the importance of seeing this not just as a substance use prevention framework. To reiterate what you were saying is that this is not just for substance use prevention, but a public health framework that can be applied to any matter of concern. It is definitely worth taking a look at. We'll have some more information about it in our show notes.
I really highly encourage you to just take a look, get to know what it's about, and see if it works for your programming. I'll bet on it that it will be. It was great to be able to see it applied in so many different departments within our organization. I would love to learn more. Can you describe how substance use prevention efforts can also be effective for SNAP-Ed implementers in community-based settings as you were starting to allude to previously?
[00:30:16] Michelle: Absolutely. It definitely goes back to your comment that the strategic prevention framework can be used by any group. It's a public health framework. People have planned their vaca-- One of the activities we do when we're training people is plan your vacation using the strategic prevention framework as an activity and a training. It's an easy way to show that, hey, we use data every day. We use it to plan, to implement, to evaluate.
I think that when it comes to SNAP-Ed, you're a key group that is doing vital work around the social determinants of health. When you think about food, it is a basic need. If I'm hungry, if our communities are not getting the nutrition they need, then they're unable to have a level of health and wellness. You are already implementing a public health approach in your work. You've got the pieces of information and dissemination. You're looking already at what are the factors that are increasing food security or reducing food and nutrition security in your communities.
I think that it's on us as prevention practitioners to ensure that people in SNAP-Ed are also coming to the table and that we are coming to your table as well to support the work that you're doing. This idea of collaborating, such as we did with the symposium in San Diego, that was a great example of how we can begin to cross-train our workforce. During the Great Recession, a lot of our coalitions in Nevada were not focused just on substance use prevention.
They began to see the need of food insecurity in our rural and remote communities, and they were some of the key catalyst for getting food to families and people in need during those years of the great recession. I don't think that that really has changed. Coalitions can be some of the go-to folks that our SNAP-Ed people are working with. I would be surprised if in our rural community some of these connections haven't already been made.
[00:32:52] Colby: Listening to you talk right there, Michelle, I'm hearing that connection is not only important on the individual level for substance use prevention, like social connection, but it's really important that our agencies are connected, that we're tapping into the strengths of each organization and really working together and coordinating our efforts.
As Tee said, substance misuse is not a siloed issue. It is tied up in a host of other adversities, so if we're just focusing on one adversity, substance misuse prevention, I think as we have been doing, it's not going to be that effective, and we're seeing that it's not that effective. How do we start changing the narrative around substance use prevention and recovery from the current one that's really shameful and stigmatizing and imposes a lot of pressure on individuals to make change, disregarding their circumstances?
How do we change it from that to the understanding that addiction is a complex brain disorder as you've been talking about?
[00:34:01] Michelle: Well, I think this idea of collaboration is key and building connections, as you said, with other agencies, with groups that are doing work to build healthier communities. Breaking out of our silos is key. As we begin to cross-train one another and continue to be curious to see that we are not working with people in a silo, these are whole human beings and whole dynamic communities that are present in the work, whether it's at the individual level, or at the community level, that require us to understand really a systems approach that we have to first challenge our own mental models, our own implicit bias, and be willing to uncover what our biases are as we're working in our silos that we can be more effective with our outreach.
I think that's one way is to begin to understand systems change. It's through that policy work, big picture work that needs to happen in terms of changing the structures that have perpetuated inequities and changing policies that are more supportive of people and communities seeking health. How do we come together to challenge our own thinking and create safe places? To do that is really key. Knowing that some populations have been overrun by dominant culture, so they need to have people who look like them, who talk like them, who advocate, and who are them to do the work.
Many of us who've been in the field of prevention for so long, it's encouraging to see new and diverse prevention workforce coming forward with an understanding of our relatedness and the complexity of the communities that they're working with and an understanding of the history that's impacting substance use, that's impacting lack of accessibility to health. It's those new leaders who are moving the dial that is going to allow for systems change and for greater collaboration for whole systems approach and greater collective impact.
[00:36:57] Tee: Yes. Mic drop on that one. I am thoroughly inspired by what you mentioned. It really starts with us. We can be one to have self-created barriers that can be removed when you take the time to visit self, think about those biases and other things that may be affecting the way we approach our programming, and to be able to create those compassionate spaces for our dynamic communities. I love that. I'm going to be using that one, but it really does start with us. We are very much a part of the systems change formula. Thank you so much for speaking with us, Michelle. It has been an absolute pleasure. How can our listeners get in touch with you and learn more about the work you do?
[00:37:52] Michelle: They can email me at M, as in Michelle, Frye, F-R-Y-E, [email protected], or they can check out the Northwest Prevention Technology Transfer Center, the Southwest Prevention Technology Transfer Center. I'm sure you will have some links available for folks to all of these. I'm happy to guide them, direct them to other resources. Thanks to all of you, your team, Leah's Pantry, for all of the people who are doing the hard work in community to bring security, the most vital security to people, food, stability, to individuals and families. It's good work. It's important work that you all are doing. I appreciate you for letting me be here today. I can't wait to continue the conversation with more people.
[00:38:49] Colby: Michelle, it has been an absolute pleasure talking with you today. I am just so inspired, like Tee said, I'm feeling really inspired about all the crossover in the type of work that we're doing because what I'm hearing from this whole interview and talking to you is that your North Star is very much the same as our North Star. Even though you're in substance misuse prevention, we're in food security, at the heart of healing both of these issues is connection and community. Even though we're technically working in different sectors, we're all going in the same direction. That feels really, really good. Before you go, we do have one last question for you, and that is, what do you stock your pantry with literally and/or figuratively?
[00:39:41] Michelle: Oh, that's a great question. I stock my pantry with, of course, there's popcorn in there [laughs]. That's my go-to snack. I also stock my pantry with I would say some compassion and flexibility because my husband, he's diabetic, and I want to put some food in there that's healthy. I also know that there are times when he needs to be able to reach for something just for comfort. There's got to be a level of good food in there, great food. Also, something that you got to go to for a snack that says this is just some comfort that I need. My pantry is all about love. Have you heard of the song, it's called A Crowded Table?
[00:40:33] Colby: I don't think I have.
[00:40:35] Michelle: It's a great song. I think for a pantry, it's a beautiful song. I think it's by The Highwomen, and basically, it's that I want to have a crowded table. I want anyone and everyone to feel like they can come and sit around my table. That is something that I grew up with as a value that my parents gave me, is that there was always room around our table for our friends, for other people. We always had a crowded table and we always had food on the table. I'm very grateful for that. I'm grateful for the work that you all do.
[00:41:14] Colby: I love that. Food is a connection for socializing. Well said.
[00:41:20] Michelle: It is. It's central to everything that we do. Also in prevention, a lot of our grants don't allow for us to offer food, which is a huge barrier to our work. Some of our efforts with community and coalitions was really trying to help them figure out how can they offer food as part of their training. Speaking of barriers and challenges, that is one that requires a lot of cross-sector collaboration and willingness to say, "Hey, I can bring the apples, I can bring the tea, I can bring the coffee." Because we know that when people have food, it reduces anxiety, it creates warmth, and what we need in order to connect in the moment.
[00:42:08] Colby: Well said. I'm going to leave it at that. That's the message. Food is connection. Coming together around food is a beautiful thing and food is central to community. Michelle, thank you so much for joining us today. It has been truly a pleasure talking to you, getting to pick your brain about this really important topic. You have brought such passion and shed such important light, insightful light on this topic. Thank you so much for joining us today for talking with us. This has just been awesome.
[00:42:45] Michelle: Well, thank you.
[00:42:46] Tee: Yes. Thank you so much again for sharing your wisdom as well as your kind words with us. As you know, connection is powerful. It's the connections between everyone because we don't just come together at a table, we're also connected to the growers, we're also connected to the producers. There's such a connection that we don't even know about that infuses all of us and actually sustains our life force.
We need food. Without connection with individuals that are doing the work and providing in this substance or providing their energy and efforts into this, then we wouldn't have what we need. We're connected on so many different levels that we don't even know. Thank you again for sharing your wisdom and the kind words, and thank you listeners for tuning in. Make sure to join us next time.
[00:43:44] Colby: Until then--
[00:43:46] Tee: Ciao.
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[00:43:48] Colby: Thank you for hanging with us. Do you know a thought leader or someone doing great work in your community? We would love to interview them and we would love to hear from you. Find us online at leahspantry.org, on Instagram at leahspantryorg, or email us at podcast at leahspantry.org. This podcast is a product of Leah's Pantry made possible by funding from the United States Department of Agriculture and their supplemental Nutrition Assistance Program, an equal opportunity provider and employer. Visit calfreshhealthyliving.org for healthy living tips.
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[00:44:40] Colby: Stocking the Pantry invites guests with a wide variety of opinions and perspectives. Guest opinions are their own and do not represent the views of Leah's Pantry.
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