Alcohol outlet oversaturation can have disastrous public health consequences (Campbell et al., 2009). Density and proximity of alcohol outlets are associated with excessive drinking (Ahern et al., 2013; Kypri et al., 2008; Schonlau et al., 2008), drug markets (Jennings et al., 2013), violent crime (Campbell et al., 2009, Franklin et al. 2010; Furr-Holden et al., 2017; Jennings et al., 2014), and fear among children (Milam et al., 2014). Even though communities with higher levels of education and income (Kanny et al., 2013) and higher white populations are more strongly associated with alcohol consumption (Chartier & Caetano, 2010), alcohol outlet oversaturation is more common in poor, minority-majority communities (LaVeist & Wallace, 2000; Pollack et al., 2015; Truong & Sturm, 2009). This suggests alcohol outlets are displaced from neighborhoods with more wealthy and white residents into disadvantaged communities and communities of color. Such disadvantaged communities are the least equipped to handle the negative public health consequences of alcohol availability and oversaturation (GyimahBrempong, 2006; Mair et al., 2013). This raises serious concerns of class and racial equity in the distribution of alcohol outlets and their associated public harms (LaVeist & Wallace, 2000).

Studies have found positive effects from decreasing alcohol outlet density (Zhang et al., 2011; Yu et al., 2008), and other researchers have asserted that the regulation of alcohol density and clustering may help decrease associated public health harms (Livingston et al., 2007; Popova et al., 2009; Campbell et al., 2009). Relatedly, the World Health Organization, the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention, and the Task Force on Community Preventative Services agree that policies regulating alcohol outlet density may help increase community safety and health (Babor, Caegano, Casswell et al., 2003; Grover & Bozzo, 1999; Campbell et al., 2009). Finally, the European Union (WHO, 1999) and the WHO Western Pacific Region (WHO, 2007) have both included alcohol outlet density regulation in their Alcohol Action Plans. To reduce the density of alcohol outlets with the goal of reducing or preventing harmful effects, communities have relied on licensing, enforcing existing regulations, and zoning regulations (Gruenewald et al., 1992; Mosher & Treffers, 2013). Zoning in particular has long been used as a public health tool to “further public good” (Ashe et al., 2003). Because zoning occurs at the and state- and municipal-level, it can be a powerful tool for local communities to take control of land use decisions (Mosher & Treffers, 2013). As early as the 19^th century, municipalities used zoning to stop the spread of tuberculosis and cholera (Ashe et al. 2003), and by 1926, the U.S. Supreme Court affirmed the State’s police power to promote safety and public health (Ransom et al., 2011). By the 1980s, states were attempting to use zoning as a tool to regulate businesses selling alcohol (Ashe et al., 2003). To date, there is little research on the effect of using zoning law to reduce alcohol outlet density/clustering.

In an effort to decrease alcohol outlet density (AOD), in 1968 the Baltimore City Liquor Board adopted legislation which banned the issuance of new Class A liquor licenses (liquor, wine, and beer packaged goods stores) within the city until AOD decreased from 2.65 per 1,000 residents to 1 per 1,000 residents (Thornton et al., 2013). In 1971, the Baltimore City zoning rewrite also restricted alcohol outlets in residential zones. All existing alcohol outlets in residential zones were labeled “non-conforming,” but were allowed to continue operating; city officials assumed these non-conforming outlets would naturally decrease over time (Thornton et al., 2013). Although alcohol outlets decreased from 2,318 in 1968 (Thornton et al., 2013) to 1,249 in 2016 (Comptroller of Maryland, 2016), Baltimore’s population simultaneously decreased from 905,759 in 1970 (U.S. Census Bureau, 1995) to 621,849 in 2016 (U.S. Census Bureau, 2016). Nearly 50 years after the passage of the zoning legislation, AOD remains at 2.01 per 1,000 residents, still well above the 1968 goal of 1 per 1,000 residents.

Research shows that as AOD increases, crime (Franklin et al., 2010; Gruenewald & Remer, 2006; Jennings et al., 2013; Livingston, 2008), alcohol consumption, (Scribner et al., 2000; Theall et al., 2011) and injuries all increase (Morrison et al., 2015). Further, high AOD concentrates in disadvantaged, minority areas (Bluthenthal et al., 2008; LaVeist & Wallace, 2000; Pollack et al., 2005; Romley et al., 2007). In Baltimore, researchers have extensively examined the relationship between alcohol outlets and public health harms; this research was used to help support policies and legislation such as TransFrom. The studies found that each additional alcohol outlet in a census tract was associated with a violent crime increase of 2.2% (Jennings et al., 2013). Second, violent crime was higher around alcohol outlets and decreased by 5.6% for every 100-foot increase in distance from the alcohol outlet (Furr-Holden et al., 2016). Relatedly, marijuana use decreased as distance to off-premise outlets increased (Milam et al., 2014). Lastly, children who passed alcohol outlets on their way to school were more likely to be offered alcohol, tobacco, or other drugs (Milam et al., 2014). To mitigate the public health consequences of alcohol outlet oversaturation, the Baltimore City Council passed the first major zoning rewrite in more than 40 years, TransForm Baltimore (hereafter referred to as TransForm). TransForm went into effect in June 2017 with new restrictions to strategically reduce AOD (TransForm Baltimore Zoning, 2016). TransForm provides a unique opportunity to examine the effects of new policy intervention on AOD by specific neighborhood type.

TransForm has the potential to dramatically alter Baltimore’s alcohol outlet landscape, and specific policy changes offer opportunity for tracking of this change. First, historically nonconforming alcohol outlets were given 2 years to either convert to a residential-conforming business or move into appropriate non-residential zones. Next, retail goods establishments selling alcoholic beverages cannot reside within 300 feet of each other with the exception of five districts. State commercial laws will also continue to impact alcohol outlet location and density. According to Maryland code §9–204.3, non-conforming licensed premises cannot be transferred within 300 or 500 feet of a school or church, depending on legislative district (Maryland Code). Licenses of outlets that do not become conforming will expire, requiring owners to cease operation and further reducing AOD. Spatial clustering of sites will decline due to TransForm zoning even if every license holder moves instead of allowing their license to expire.

Because this zoning code re-write is unprecedented, many questions remain about its effects on alcohol outlet density. The objectives of this study are threefold: (1) determine how TransForm changes the number of non-conforming off-premise alcohol outlets, including historically non-conforming/grandfathered outlets; (2) determine where off-premise nonconforming outlets can move based on a GIS analysis of available parcels; and (3) analyze the community demographics of the census tracts where off-premise outlets currently exist. This study will only look at off-premise alcohol outlets, otherwise known as packaged goods stores (PGS) or liquor stores (where customers purchase alcohol for consumption at another location), in comparison to on-premise alcohol outlets (where customers purchase and consume alcoholic beverages on site). Our hypothesis is that non-conforming PGS will currently cluster in census tracts with lower socioeconomic status and higher populations of minorities; further, we hypothesize that non-conforming PGS will have greater opportunity to move to areas with similar socioeconomic characteristics. As such, TransForm may disperse the social and health inequity inherent in the clustering of PGS, but not necessarily ameliorate it. We therefore examine the effects of the new zoning code on the potential re-distribution of PGS and provide empirical support for the need to actively monitor redistribution of outlets to avoid further inequitable oversaturation in disadvantaged neighborhoods.

To determine the potential re-distribution of PGS in Baltimore City we identify which are non-conforming by addressing 3 restrictions: (1) zoning; (2) local laws; and (3) state laws. A geospatial approach highlighting PGS locations and potential future sites is required for this analysis. Data on all 263 PGS were obtained from the Board of Liquor License Commissioners for Baltimore City and geocoded using ArcGIS (ESRI, 2016). Since automated geocoding uses a line-based streets file to place points within a designated offset street distance, automatically placed points occasionally end up on the edge of a road or between parcels. Thirty PGS that fell outside the land parcel layer provided by the Baltimore City Department of Planning were moved to the location of existing PGS within their respective parcels. We repeated this process with public schools and religious building data obtained from the Mayor’s Office of Information Technology (2017) via OpenBaltimore (Mayor’s Office of Information Technology, 2017).

Our goals were threefold: (1) determine how the new zoning created by TransForm Baltimore rewrite changes the number of non-conforming PGS; (2) determine where PGS can move based on a GIS analysis of available parcels; and (3) analyze community demographics where PGS currently exist. We found that 172 of the 263 PGS (65%) were in a residential zone or within 300 feet of a school, church, or another PGS, either recently or historically. Of these, 99 PGS in residential zones will have 2 years to relocate or convert their PGS into a zoning conforming business. Post-TransForm, Baltimore City will have 5,753 land parcels where alcohol outlets may locate, a 27.2% reduction from the Pre-TransForm land parcel total of 7,903. We also found that the majority of PGS are currently in communities with higher Black populations, single parent families, household poverty and vacancy, and unemployment when compared to citywide community (CSA) averages which is consistent with prior studies (LaVeist & Wallace, 2000; Furr-Holden et al., 2016; Jennings et al., 2014).

The Sandtown-Winchester/Harlem Park CSA has been predominately Black since 1940, while Southwest Baltimore and Greater Rosemont CSAs have been predominately Black since the 1960s. These 3 residential communities account for the most PGS, containing 11, 18, and 13, respectively. Potentially, they had the most to gain from the Baltimore City zoning rewrite of 1971 because 32 of the 42 PGS within them are non-conforming. Because existing outlets were grandfathered in, however, these three communities ultimately suffered the most from the oversaturation of PGS. Currently, these communities have the greatest proportion of vacant units, and some of the lowest SES in Baltimore. When the 32 PGS in these communities close, change business type, or relocate to other communities, future research will be needed to assess whether the amelioration of PGS density improves community health.

The downtown communities of Downtown/Seton Hill, Greater Charles Village/Barclay, and Midtown are predominately White and have higher than average SES. These communities are mostly non-residential and account for almost one fifth of parcels remaining eligible to PGS. Empirically, one would expect more PGS to relocate to these communities; however, given their political capital and collective efficacy, this remains to be seen. Specifically, Downtown/Seton Hill is mostly commercial and accounts for 8.8% of the remaining PGS eligible parcels. While TransForm will help ameliorate the overconcentration of alcohol outlets in Baltimore City as a whole, one concern is that some communities may experience negative spillover effects. We suspect these spillover effects will be influenced by a variety of complex factors, including active community associations, political capital, and collective efficacy.

Community-specific density policies may help prevent spillover effects. One option would be to set a blanket density goal for every CSA, regardless of their geographies or demographics. A second option would determine how many outlets individual communities can handle by examining their geographies and social characteristics. Both policies would need a way to identify alcohol outlets to close. Using distance parameters, like those in TransForm, is ideal for identifying these outlets. Residents may then discuss further options to meet the goal of reducing AOD. Future research focused on assessing the needs of each CSA (i.e. grocery stores, recreation centers, medical clinics, etc.) may aid this process.

This work is of great value to public policymakers—as well as researchers examining the effects of AOD on community health—because it models the effect of a new policy intervention on AOD by community type. By using GIS at both the community and parcel level, we identified and predicted the potential indirect impacts of TransForm within municipalities. The changes in PGS density in various communities in Baltimore City could be of particular interest to researchers interested in the relationship between AOD, crime, and community disadvantage.

This zoning change could also play a vital role in reducing food deserts in Baltimore City (defined as “vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas;” American Nutrition Association, 2015). City officials could work with PGS owners to help them re-establish as healthy food stores or other essential services and businesses that are needed. Such work will not only remove pathogenic characteristics associated with PGS and other alcohol outlets, but also build toward creating environments with salutogenic characteristics, such as healthy food stores. Other municipalities outside of Baltimore can likewise explore how zoning rewrites may be able to simultaneously decrease the negative effects of and alcohol availability and food deserts. They can use this work to understand the potential implications of proposing reductions in AOD through zoning tools. As seen here, while density may go down overall, Baltimore may experience a spreading out of alcohol outlets into currently disadvantaged communities, further snowballing public health issues. It is unclear whether such changes might have unintended consequences in other communities, but it merits deliberate consideration.

Future work is needed to examine the intended and unintended effects of TransForm at the city and community level. The 99 PGS in direct violation of TransForm have 2 years to become compliant. While some may transform into other business types or close, many will likely move. This gives a rare opportunity to predict where PGS may move, based on the information available on the geographies and general demographics. Further, longitudinal analysis will be required to monitor the effects of TransForm. Some communities are likely to increase in PGS density, others will likely decrease. These potential shifts in PGS density need to be actively monitored. Relocation may follow patterns that could help predict not only where other PGS are likely to move in Baltimore, but the types of neighborhoods where PGS may gravitate towards in other cities that eventually pass similar zoning rewrites to control AOD. This would be of particular interest to other cities with declining populations such as those in the Rust Belt. According to Hollander and others (2009), urban planning in the U.S. has focused too narrowly on managing or revitalizing urban growth, but little empirical work has been conducted on land use change in shrinking cities. Cities such as St. Louis, Cleveland, Buffalo, Pittsburgh, and Detroit—which have all lost over half their populations—are likely to have an excessive number of alcohol outlets (Sakaguchi et al., 2014). Ultimately, continued research in Baltimore will help unravel the temporal relationship between AOD and community decline and help establish a causal link between the two, work that is of particular interest to other declining cities and may provide an effective policy tool for addressing this concern.

Baltimore City is just one of many U.S. cities experiencing a dramatic decline in population. Without direct intervention, the AOD in these cities will continue to increase, which could have disastrous public health consequences (Campbell et al, 2009). The goal of this study was to evaluate the potential impact of new zoning legislation (TransForm Baltimore) on locations of alcohol outlets. This was accomplished by geocoding existing PGS and using both pre- and post-TransForm zoning files to identify various past and present PGS violations. Socioeconomic variables were obtained and used to explain the PGS landscape in-depth. While 172 of the 263 PGS in Baltimore City violate zoning, the 99 found in residential zones (including 90 historically non-conforming) have 2 years to relocate or become compliant. To date, little research exists on the effect of using zoning law to reduce alcohol outlet density/clustering, thus the outcomes of TransForm need to be closely monitored to determine the efficacy of using this approach in other cities, particularly those with declining populations.