"Everything just fell into place," said Vargas, who has worked on this effort from the beginning. Though the survey had previously been seen as controversial, attitudes suddenly changed. Money became available, the Macon County School Board gave its approval, and principals and teachers cooperated with the effort.

The survey used in the county was closer to the CDC national version than the "watered down" one used in the state at that time, Vargas said.

"We decided to do it the right way."

Macon County was something of a trailblazer among North Carolina counties. Vargas said that Healthy Carolinian chapters throughout the state began calling HCMC director Kathy McGaha with questions.

Since then, the survey has been give two more times in the county, in 2005 and 2007. It is now given at the same time as the state survey, which allows for better comparison of the data.

"The first time, there was some negative feedback," Vargas said. People felt some of the results might just be a "fluke." However, he said, "over time the trends have shown consistency."

The data has allowed the community to craft programs that address areas of concern, and measure their success. For example, one set of questions shows how safe students feel at school. Vargas said the trend line in this area shows progress in addressing the issue of school safety, thanks to proactive measures taken by the community.

Today, Vargas said, Mars Hill College has a dedicated staff person doing YRBS results statewide - "partly because of our hiring them to analyze the 2002 data."

The fact that the YRBS is now given routinely is "one of the great achievements" of HCMC, Vargas said.

The 2007 YRBS can be viewed online at maconnc.org//healthdept/Macon2007YRBSFinal2-26-08.pdf.

When she began working, the ratio of nurses to students was 1:2,366 for elementary schools only. Today, all children are served and the ratio is 1:1,009. The county has four certified school nurses; a fifth nurse has been hired and is getting her certification.

Another achievement was the creation of the School Health Advisory Committee (SHAC), which works to achieve a unified school health program. SHAC has strengthened the relationship between the Public Health Center and the schools, and has become a state model for the ability of schools to work with the community to improve children's health, Garrett said.

She also mentioned the health screenings that are given to all children in grades K-8. Parents are informed of any concerns and the school nurses help "bridge parents back to the health department" and help parents "maneuver the health care system," if needed.

Roberta Swank, a member of the Macon County Board of Education, spoke of being able to hire a health educator for the schools for the first time. "We need another position, but there is no money now," she said, urging everyone to speak up about the needs they see.

"Healthy Carolinians identified childhood obesity as a priority in 2000," she said. The school health screenings provided information from BMIs showing that Macon County students rated "a little worse than nationally" on this measure.

"Several subcommittees worked on this," Barr said. Their efforts have helped create more walking trails in the community. The Greenway opened in 2002, and in 2003, microgrants administered by HCMC aided construction of trails on Lakeside Drive and in Cartoogechaye. In 2004, HCMC worked with Friends of the Greenway to build Wesley's Playground.

Barr said "advocating for good choices" continues. For example, a low-fat milk campaign has encouraged more children to choose skim milk.

Most recently, she said, the Public Health Center and the chronic disease committee of HCMC have worked in the area of church wellness with the "Walk to Jerusalem" project, which engaged people of all ages in healthier living.

She described the bleak period in the late 1990s and early 2000s, when Medicaid clients had to be sent outside the county for service, sometimes as far as Chapel Hill.

In 2004, there were 926 Medicaid-eligible children in the county with no access to dental care, she said.

Today, two public health dentists serve the needs of both children and adults. In 2006-07, the mobile dental unit made nearly 2,000 visits to Medicaid-enrolled children.

In 1998, the dentist to patient ratio in Macon County was 1:4,090, McGill said. Today, it is 1:1,799.

"The heartbreak stories put us into gear," said HCMC director Kathy McGaha.

The program is funded by community organizations and churches, Franks said. "Volunteers keep the program going."

"We address any medication need that people have," she said.

Bottomley offered his personal story of addiction, which, 20 years ago, "took from me everything that I had."

"An individual reached out and offered me a home I could live in while I got my life back together," he said. He became a successful in business and eventually moved to Franklin.

He spoke of his surprise that there were no recovery homes or detox centers in this area at that time.

Bottomley and others on the Substance Abuse Taskforce began trying to bring a recovery home to Franklin. He got contact information on the Oxford House and arranged presentations for HCMC and Zonta. The publicity helped get the word out and soon somebody called with a house.

"Two years ago, it came into being," he said. "I am personally humble to have had something to do with this, and proud to have some of these women as friends."

One of the current residents of the Oxford House spoke about how it has impacted her life. She has lived at the house for 10 months, she said, and in six weeks will celebrate "one year clean."

She said feedback on the fair has been "very good," with participants commenting on the fact that they "actually get to see somebody and not just pick up a brochure."

The expo presents seminars and health screenings and attempts to let people know what services are available, she said.

By 2007, 87 percent of Macon County restaurants were tobacco-free, the second-highest in the state. All schools and both hospitals in the county also have tobacco-free campuses.

Educational programs have alerted teens to the subtle ways manufacturers pull them in and get them to buy tobacco products, and to the dangers of smokeless tobacco.

Hollifield said the YRBS has shown an increase in the number of kids who said they never smoked a cigarette, from 65 percent in 2002 to 76 percent in 2007. "We're making changes," she said.

Efforts to educate teens about the dangers of tobacco continue. TATU (teens against tobacco use) has eight to 10 active members who go out and speak on the subject.

Alexander said she was "shocked" to find out about spit tobacco. One can of Copenhagen has as much nicotine as four packs of cigarettes, she said. New products on the market are designed to let people hide their nicotine.

"We need to help kids and adults get off tobacco and prevent disease and death," she said.