MEDICINSKI GLASNIK

INTRODUCTION
Cardiovascular diseases (CVDs) are the major
cause of death in most European transitional
countries (1). In Croatia CVDs are the leading
cause of death and account for more than half of
the overall mortality (2,3). Unfortunately, exact
data on the spread of the most important risk factors,
such as hypertension, smoking, obesity, hypercholesterolemia,
hypertriglyceridemia, insufficient
physical activity etc. were not available
prior to Croatian Adult Health Survey (CAHS) in
2003. It provided timely, reliable, cross-sectional
estimates, supporting the development of a public
health information system, health promotion,
with emphasis on CVD prevention, CVD risk reduction
and healthier lifestyles promotion among
the general population (4). Furthermore, there
have been no systematic and comparable studies
of the risk factors on a representative sample of
the population at the national as well as the regional
level.
Although CVDs account for more than half
of the overall mortality in Croatia, the support for
the research in this area, during the last decade,
has not been sufficient. In the period between 1991
and 2004, Croatia had the lowest CVD publication
rates (in 2003 the estimated proportion was
1.2% as opposed to 7.3-11.8% in other analysed
countries) in the MEDLINE database among the
countries included into the analysis (5).
The mortality caused by CVDs in the population
can be significantly reduced by acquiring a
healthier way of life such as non-smoking, proper
diet and regular physical activity. It is well known
that health promotion and primary prevention are
of substantial importance in decreasing CVD
mortality and morbidity (5).
One of the main hypotheses in our research
program on health status and health behavior in
adult population of the Croatian Western region
was a high prevalence of CVDs risk factors with
gender and age differences and different hierarchy
in the prevalence of selected behavioral risk factors
for CVDs as compared with the national level.
Malatestinićet al Smoking in the Croatian Western Region
PARTICIPANTS AND METHODS
Participants
The data were collected in the summer of
2003, and results have been officially released in
December 2003 in the cross-sectional survey entitled
“Croatian Adult Health Survey” (CAHS)
(6). The main goal of the survey was to examine
the health status, risk factors and health care utilization
with a focus on cardiovascular diseases
(CVDs). Conceptually, the survey was based on
existing studies such as the CINDI (7,8), and Short
Form 36 of the World Health Organization (9).
The development, design and implementation
of the 2003 CAHS was conducted by
the Canadian Society of International Health,
Croatian Ministry of Health, Croatian Central
Bureau of Statistics, Andrija Štampar School of
Public Health and the National Institute of Public
Health, Zagreb, Croatia, and the cooperation resulted
in completion of a high quality population
health survey that provided first comparable data
at a regional level.
A sample design for the 2003 CAHS covered
approximately 98% of the Croatian population
aged 18 and older, due to exclusion of people living
in non-conventional dwellings, stationed in institutions,
full-time members of the Croatian Armed
Forces and residents of some remote regions.
Observed regions
The 2003 CAHS used the official definition of
the five sub-national regions (groupings of counties)
as proposed by the Central Bureau of Statistics.
In order to ensure sufficient/representative
sample for Zagreb (the capital), it was removed
from the Central region and considered as the
sixth region for the 2003 CAHS. Using the 2001
Census of Households, the six main regions were
further stratified according to the city type (town/
municipality) and counties to account for population
differences. Overall, as the country was
stratified into 20 design strata a sample of 11,250
units was required to meet the survey objectives
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