State of the evidence on economic impacts of smoke-free policies in the tourism sector: A narrative literature review.

Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) obligates Parties to enact policies that create 100% smoke-free environments in enclosed workplaces, public places and public transport. This narrative literature review examines studies reporting economic impact of smoke-free policies on tourism industry sectors including hotels, casinos/gambling venues, and sporting venues. A literature search was conducted across academic and gray literature published between 1 January 2004 and 18 June 2024, using the Scopus, Embase, and JSTOR databases. Search terms included variations of 'smoke-free' and 'tourism', 'hospitality', 'casino', 'hotel', and other related terms. Studies were included if they reported direct or indirect economic impacts of smoke-free policies on the tourism sector. The screening process involved an initial review of titles and abstracts, followed by full-text assessment for eligibility. Database searching identified 692 articles, of which 37 met the inclusion criteria. Nearly all identified studies (95%) focused on economic impacts in high income countries. The majority (76%) reported neutral or positive economic impacts following the implementation of smoke-free policies. There is evidence that most hotels and other hospitality venues experienced stable or improved revenues, increased customer satisfaction, and enhanced employee health outcomes after going smoke-free. Some evidence indicates that certain casinos experienced short-term revenue declines. Comprehensive smoke-free policies were more consistently associated with economic benefits, while partial policies often produced mixed results, commonly attributed to enforcement challenges. This review supports the evidence that comprehensive smoke-free policies aligned with WHO FCTC Article 8 deliver both health and economic benefits without harming the tourism sector. Findings can help policymakers counter tobacco industry claims and build political support for stronger smoke-free policies, especially in tourism-dependent jurisdictions. The lack of studies from low- and middle-income countries highlights the need for further research in these contexts.