According to the DPH study, almost 20 percent of West Hollywood residents smoke, compared to about 14 percent in Los Angeles County. Out of 127 municipalities in the county, West Hollywood ranked 124th, with the fourth-highest rate of smoking per capita.

The study comes as West Hollywood continues work to draft an ordinance that would restrict smoking in outdoor public spaces, including on restaurant and bar patios.

“The numbers demonstrate that we need to do more,” West Hollywood Mayor John Heilman said. “A ban on smoking in certain locations doesn’t fully address the problem. We have to look at other strategies as well.”

Heilman said the city would look into sponsoring smoking cessation programs, as well as partnering with schools and agencies that provide social services to expand anti-smoking education efforts.

Heilman also noted that West Hollywood’s Russian-speaking population, and the LGBT population, smoke at a higher rate, demographically, than the population at large.

Susan Cohen, director of health education at the L.A. Gay & Lesbian Center, said that smoking and other substance abuse remains an ongoing issue in the LGBT community.

“I’ve seen smoking in upwards of 30 to 40 percent of the LGBT community,” Cohen said. “I definitely think that’s due to some of the stresses that LGBT people experience with coming out and living in a homophobic society. I think that smoking and alcohol and crystal meth use are the big three substances that come up over and over again in our community. For a lot of people, the coming out process is associated with tobacco and alcohol use.”

Cohen said she also thought the importance of bar culture in the LGBT community helped account for the higher smoking rates.

“I think that there are very few social alternatives for the LGBT community that don’t involve alcohol,” Cohen said. “There’s a large reliance on the club scene and the anonymity of the club scene. But I’m glad to say that’s really changing. Now more than ever, if you want to find ways of socializing that don’t involve substances, you can.”

Though smoking inside bars and restaurants is illegal in California, patrons of West Hollywood bars can currently smoke on outdoor patios. In January, the Los Angeles City Council adopted an ordinance that banned smoking on patios as well, which will go into effect next year. In June, Starbucks also banned smoking on outdoor patios at all of its California locations.

The West Hollywood City Council has created a task force that is currently working to draft a similar ordinance, which the City Council may choose to accept, alter or reject. The task force is made up of local business owners, residents and health advocates, who often find their goals at odds.

Nick Lam, bar manager at Saint Felix, a bar and restaurant on Santa Monica Boulevard with an outdoor patio, said many of the bar owners he knows are against the ban.

“We’re all against it, for a number of reasons,” Lam said. “Everyone realizes it’s going to hurt business. People are always asking for tables outside so they can smoke. If people have to walk all the way out to the curb, it makes things messier. If they’re drunk, they might forget about their tabs. It’s illegal to smoke inside, but smoking is still legal, so we have to give people somewhere to go.”

However, Steven Gallegos, who has helped draft similar smoking bans in many other cities in California and now serves on the West Hollywood task force, said the most important issue is public health.

“Where I’m coming from, this is a public health issue,” Gallegos said. “It’s always been a public health issue, and it always will be a public health issue.  The smoke-free ordinance isn’t just for the customers. It’s also for the people that work there. They’re breathing in that second-hand smoke, and it poisons employees. What about people who are susceptible to asthma and emphysema? Eighty-six percent of L.A. County residents don’t smoke, and we need to make sure that they have safe workplaces.”

Gallegos is the only public health advocate serving on the task force, which is made up almost exclusively of local business owners, he said. Still, he is encouraged by the progress the group has made.

“The issue is morphing, and they’re talking more about how we can make this happen without hurting the bottom line,” Gallegos said. “When they see the largest coffee company in the world, Starbucks, say no more outdoor smoking in our areas, they’re starting to see the writing on the wall. They see that it will be better for them to do it in West Hollywood where they have some input, rather than waiting for the state to make it illegal.”

Still, not everyone agrees that a smoking ban is a fitting policy for West Hollywood. Mayor Pro Tempore, John Duran, was the only member of the city council who voted against instructing city staff to draft an ordinance banning smoking on patios.

“Based on the history of the city always being different and unique from the rest of the county, with a vibrant nightlife unlike anywhere else in L.A. county, I don’t think this ban makes sense for West Hollywood,” Duran said. “This part of L.A. County has always been about nonconformity, defiance, individual liberty, people doing their own thing. That’s the essence of West Hollywood, and that’s why these bans are so contrary to the essence of what this place is. We’re not talking about Pasadena, with due respect, where it’s a little more family oriented. This is West Hollywood.”

Instead, Duran suggested a public education campaign would prove more effective in reducing the city’s smoking rates.

“If my colleagues had proposed a public education campaign to get people to give up smoking, I would have supported that wholeheartedly,” Duran said. “In a community of people who are by their very nature defiant, I do not think the ban will work. All it does it cause resentment and resistance. I think a public education campaign, much like the ones done against crystal meth and drunk driving, would be much more effective, and help put cigarettes in the same category.”