After 38 years of smoking, Jean Laging has just reached six months without a cigarette. A senior executive assistant from Minneapolis, Laging has tried to quit four times and, until recently, was one of about 19 percent of Minnesota adults who still smoke.

“I’m a cig-aholic,” she confessed recently. “I would love to take a drag off a cigarette right now.”

Cigarette use in Minnesota and nationally has plummeted in the past two decades, but a recent study shows there are pockets around the state where smoking rates remain stubbornly high as smokers struggle with the same challenges Laging has faced.

Factors such as income, education and addiction levels appear to be key influences. Across Minnesota, for example, counties with lower incomes saw smoking rates decline more slowly than areas with higher incomes, according to a recent national study by the Institute for Health Metrics and Evaluation.

Mahnomen and Pine counties, where median incomes hover around $40,000, recorded adult smoking rates of 28 percent and 26 percent. By contrast, only about 15 percent of adults smoked in Carver and Scott counties, where the median income is above $80,000.

The county data from the institute differs slightly from that of the Minnesota Adult Tobacco Survey, which is conducted every four years by the state Department of Health and ClearWay Minnesota. But its findings underscore the challenges that health officials face in the long battle to reduce tobacco use.

More than 480,000 Americans die from complications related to cigarette smoking each year — one in five American deaths — and more than 16 million Americans suffer from a smoking-related disease, according to the U.S. Centers for Disease Control and Prevention.

Minnesota’s smoking rates have been below the national average for more than a decade, according to the last Minnesota survey. But without drilling down into county-level data, big metro areas can dominate the research, said Dr. Ali Mokdad, a University of Washington professor and researcher on the study.

“You will miss the real issues,” Mokdad said.

Myths about stress

Smokers in Minnesota tend to be young, with lower incomes and fewer years of education, according to the 2010 Minnesota Tobacco Survey.

Smoking prevalence is “almost nil” among adults with a college education, said Dr. Raymond Boyle, a researcher with ClearWay Minnesota, a nonprofit organization that improves the health of Minnesotans by reducing tobacco use and exposure.

He said tobacco industry marketing in low-income communities may also affect smoking prevalence in those places.

But education and income aren’t the only clues to the puzzle.

About 59 percent of American Indians smoke, according to the Minnesota Department of Health, a pattern confirmed by the institute’s county data.

Stress, whether from economic pressure or life events, can also be a driving force, researchers say. On Minnesota’s Iron Range, where smoking was part of the rugged industrial culture for years, most counties have smoking rates well above the state average.

But the idea that cigarettes calm the body, Boyle said, is “simply not true.” Nicotine is a psychoactive drug that reaches the brain very quickly, he said, releasing dopamine within seconds. It’s easy to assume that lighting up will take the rough edges off a bad day.

In reality, Boyle said, “it’s doing the exact opposite.” A 2010 London University of Medicine and Dentistry study found that 41 percent of smokers who managed to stay abstinent for a year had a decrease in perceived stress.

While smoking rates are higher in lower income counties, sharp increases in cigarette prices and taxes — including a $1.60 tax hike that took effect last year — have not always worked as a deterrent. The price of tobacco accounted for 43 percent of the reasons why Minnesotans quit smoking from 1993 to 2011, according to ClearWay data.

“It didn’t bother me,” Laging said. “If you want to smoke, you’ll find a way to get the cigarettes.”

Anyone who hasn’t been addicted to something may never be able to “wrap their heads around” the stress and challenges involved with smoking and quitting, Laging said. “It’s a really screwed up habit.”