MARTINEZ -- Laurie Comstock lost her sister and father to smoking-related illnesses and was appalled to learn that Contra Costa County isn't spending every dollar possible to prevent kids from lighting up.

"My sister was smoking when she was 13 and died at 44," said Comstock, a former resident of Concord who lives in Sacramento. The county does not use any of its $9 million share of a nationwide tobacco lawsuit settlement on tobacco education, and local anti-smoking advocates want to change that. The money instead is used to help pay for patients with no medical insurance. Approximately 360,000 patients visit Contra Costa Regional Medical Center and county clinics for outpatient care, said Dr. William Walker, head of the county's Health Services Department. It's hard to estimate how many of those patients are uninsured, but it's a huge number, he said. Without the tobacco money, the Board of Supervisors would have to cut services or cut other county programs to help fund services for the uninsured, Walker said. He estimates that the county spends about $2 million on tobacco education. "The most effective smoking cessation effort out there is a one-on-one interaction between a patient and a physician who says 'You've got to stop smoking,'" Walker said. By then it's too late, said Janice Turner, who is a member of the Tobacco Prevention Coalition and a health educator with the American Lung Association. "Those people are already sick and already dying," she said. The way to prevent smoking-related illness is to prevent young people from smoking, she said. Uninsured patients are a small percentage of county residents, Turner said. "What about the other residents in the county?" she asked. "They should be allowed to reduce their risk." Although there are no rules for how counties must spend the settlement money, other Bay Area counties have earmarked some of their shares for tobacco prevention, said Paul Fletcher of the Lung Association. Last year, Alameda County budgeted $2 million of its share for anti-tobacco and other public health campaigns, including AIDS prevention and the expansion of dental care for seniors and children, said David Brown, chief of staff for Supervisor Alice Lai-Bitker. The Contra Costa Board of Supervisors likely will discuss the tobacco settlement money when it holds budget hearings at the end of the month. Supervisors are interested in tobacco education but must not forget the needs of the uninsured, many of whom are children, said Supervisor Gayle Uilkema. "We've got two extremely worthy programs," she said. "It's very hard emotionally to say that I am going to be willing to decrease substantially what we spend on uninsured children." Supervisor Mark DeSaulnier said he is willing to seek more funding for tobacco prevention in the budget, but said the money is scarce.

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