OBJECTIVE: After the COVID-19 pandemic onset, several U.S. states passed legislation to begin or expand direct-to-consumer (DTC) alcohol home delivery. We examined changes in DTC use and associations between DTC use, drinking patterns, and negative consequences by different DTC policies.
METHOD: We conducted a cross-sectional, retrospective survey of 5,360 U.S. adults who consumed alcohol (ages 21-62 years), using an online Qualtrics survey panel. Participants were recruited from 18 states representing four DTC policy groupings pertaining to on- and off-premises outlets (no DTC, no change in existing DTC policy, new DTC policy, expanded DTC policy). DTC use and drinking patterns (average drinks/week, binge drinking days/month) were self-reported for four pandemic-related periods at pre- (2019-February 2020), early (March-May 2020), mid- (June 2020-March 2021), and late pandemic (April 2021-October 2023). Participants self-reported the total number of negative drinking consequences (out of 17) they experienced during the entire pandemic. Multivariate regressions examined time and policy group predicting DTC use, time and DTC use predicting drinking patterns, and DTC use and drinks/week predicting negative consequences.
RESULTS: Compared to adults in states with no delivery, odds of DTC use were highest among adults in states that expanded DTC policies (odds ratio [OR] = 2.11, 95% confidence interval [CI] [1.78, 2.50]). DTC use was associated with consuming approximately 4.43 (p < .001) more average drinks per week, more binge days per month (incidence rate ratio [IRR] = 1.33, 95% CI [1.27, 1.39]), and more negative consequences (IRR = 1.28, 95% CI [1.17, 1.39]), controlling for current drinking.
CONCLUSIONS: Our findings suggest that expanding DTC delivery policies increased alcohol accessibility, and DTC use was associated with increases in excessive alcohol use and consequences. Such data can inform future decisions about states' DTC alcohol policies. [Author's abstract]