title: The public's perspectives on advance directives: implications for state legislative and regulatory policy.
abstract: OBJECTIVE
  Determine 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.
  
  
  METHODS
  Cross-sectional survey administered over the telephone to a representative age-stratified random sample of 1195 Maryland adults.
  
  
  RESULTS
  Approximately 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.
  
  
  CONCLUSIONS
  Barriers 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.
authors.affiliation: 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
authors.forename: Keshia M
authors.initials: KM
authors.lastname: Pollack
authors.forename: Dan
authors.initials: D
authors.lastname: Morhaim
authors.forename: Michael A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence*; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011639:Public Opinion