Health tourism is a broad concept that incorporates both medical and wellness tourism. Sareyn, city of Ardabil province, is one of the largest and the most diverse cities for health tourism. Although health tourism in Iran is in its infancy, it can offer new opportunities, and strengthen the overall competitiveness of Iran's tourism industry. In this paper, by using strengths, weaknesses, opportunities and threats (SWOT) analysis, the strengths and opportunities for sustainable health tourism are determined. Also, weaknesses and threats are recognized; finally, guidelines for efficiently using the strengths and transforming the weaknesses into opportunities and strengths are presented.

This study examines how climatic factors influence the predictive power of LEED credits in determining certification outcomes for hotel buildings across the United States. Using data from 259 LEED-NC v2009 certified hotels, project-level information was integrated with 30-year climate normals from the PRISM database and Building America climate zones. A three-step hierarchical linear regression was conducted to identify the LEED credits that most strongly predict total certification points while controlling for project size, certification year, and baseline climatic conditions, and to test whether climatic factors moderate these relationships. Regularized Linear Regression (LASSO) was then applied to address multicollinearity and assess model stability, followed by Support Vector Regression (SVR) to capture potential nonlinear relationships. This integrated methodological framework, combining hierarchical regression for interpretability, LASSO for coefficient stability, and Support Vector Regression for nonlinear verification, provides a novel, multi-dimensional assessment of climate-sensitive credit behavior at the individual credit level. Results show that energy- and site-related credits, particularly Optimize Energy Performance (EA1), On-Site Renewable Energy (EA2), Green Power (EA6), and Alternative Transportation (SS4), consistently dominate LEED performance across all climate zones. In contrast, indoor environmental quality credits exhibit modest but significant climate sensitivity: higher mean temperatures reduce the contribution of Increased Ventilation (EQ2) while slightly enhancing Outdoor Air Delivery Monitoring (EQ1). Cross-model consistency confirms the robustness of these findings. The findings highlight the need for climate-responsive benchmarking of indoor environmental quality credits to improve regional equity and advance the next generation of climate-adaptive LEED standards.

As sustainability becomes an essential approach in the USA hospitality sector, green certifications like Leadership in Energy and Environmental Design (LEED) are increasingly adopted by hotel developers. However, the extent to which different LEED certification levels influence guest satisfaction remains unclear. This study investigates how the LEED certification level interacts with the relationship between a hotel’s sustainability performance and guest satisfaction in the United States. A mixed-methods approach was used, combining Random Forest Regression and the Process macro on a dataset of LEED-certified USA hotels with normalized guest satisfaction scores. The Random Forest model identified Energy and Atmosphere (EA) and Indoor Environmental Quality (EQ) as the most influential LEED categories in predicting satisfaction. Additionally, the results reveal that the positive effect of sustainability on satisfaction is strongest at the lower LEED levels (Certified and Silver), but shows diminishing returns at higher levels (Gold and Platinum), suggesting that an increased sustainability performance does not uniformly improve guest experience. These findings support all three hypotheses and offer practical insights for hotel developers, operators, and certification bodies seeking to align sustainability strategies with guest expectations.