• Keshia M Pollack, Dan Morhaim, and Michael A Williams.
• Department of Health Policy and Management, Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. kpollack@jhsph.edu
• Health Policy. 2010 Jun 1;96(1):57-63.

ObjectivesDetermine the prevalence of advance directives (ADs) in Maryland and identify the barriers and enablers to their adoption, in order to guide the formulation of state legislative policy.MethodsCross-sectional survey administered over the telephone to a representative age-stratified random sample of 1195 Maryland adults.ResultsApproximately 34% (n=401) of Maryland adults reported having an AD. Older adults (65+ years) were more likely than younger adults (18-64 years) to have ADs (p<0.001); the proportional difference between those with and without ADs diminished as age increased. Two times as many Whites than Blacks reported having ADs (43-23%; p<0.001). Of those who had an AD, the primary motivations for creating one was a personal medical condition or a diagnosis to one's self or a family/friend (41%). Those without ADs identified lack of familiarity with them (27%), being too young or healthy to need one (14%), or uncertainty of the process for adopting one (11%) as reasons for not having one.ConclusionsBarriers to AD adoption appear amenable to policy interventions. Policies that seek to increase access and ensure ease of enrollment, combined with a targeted public health advocacy campaign, may help increase the prevalence of ADs.Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

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