The Community Health Demonstration Project (CHDP) was organized to develop, implement, and evaluate substance abuse prevention programming in a resource-poor rural Appalachian area. The goals of the CHDP were to develop new community-initiated and community-based programs and services for the prevention of alcohol, tobacco, and other drug (ATOD) use during pregnancy and for the first 2 years after birth by women and their families in the target community, to increase use of prevention services, and thereby to reduce ATOD use among this population. Measurable results of the community wide prevention project included increased awareness and knowledge of problems associated with ATOD use during pregnancy and postpartum, new services adopted by local agencies and organizations, more cooperative efforts to provide prevention programs for all ages throughout the community, a range of new or expanded programs to enhance development, and a reduction in ATOD use during and after pregnancy by women in this rural area.