{"doi":"10.1111/add.14963","title":"Commentary on Beard <i>et al</i>. (2019): A systematic approach sharpens insights on e‐cigarettes and smoking cessation","abstract":"Examining use of e-cigarettes during quit attempts as a key exposure variable and then controlling for the potential impact of other population-level cessation efforts provides important insights into the UK smoking cessation experience. This approach can inform analyses of tobacco control policy and other public health interventions in the United Kingdom and abroad. Beard et al. rigorously examine one of the most pressing questions in tobacco control today: do e-cigarettes affect smoking cessation at the population level 1? While the authors cite controversy from previous reviews on this topic, our work has identified that few studies purporting to report on the effect of e-cigarettes on smoking cessation or reduction actually do so, and that appropriate study design and measurement are limitations to answering this question 2, 3. Beard et al. 1 advance the evidence base by addressing key factors in their analyses that have not been addressed in other studies, specifically, examining use of e-cigarettes during a quit attempt as a key exposure variable and controlling for the potential impact of other population-level tobacco control efforts. They found that e-cigarette use was associated with a small increase in overall population quit rates (regardless of reason for use), that e-cigarette use among current smokers was not correlated with the prevalence of quit attempts or cigarette consumption and that using e-cigarettes during a quit attempt was positively associated with quit success. However, the study contains another important finding: increasing the minimum purchasing age, spending on a national tobacco control mass media campaign, and other policy efforts did more to decrease smoking prevalence than use of e-cigarettes. Analyses such as this, which facilitates direct comparison across the probable drivers of smoking cessation, allow for discussion of the relative reach and magnitude of effect of each driver. Beard et al.'s findings emphasize that no one product or policy will reduce tobacco's toll on public health. Instead, we must continue to support proven strategies to reduce smoking prevalence as we learn to maximize benefits and minimize harms of e-cigarette use at the population level. Interestingly, Beard et al.'s findings in the United Kingdom 1, 4 are similar to recent findings from two population-level studies in the United States that do not include measurement of e-cigarette use specifically for cessation 5-7. Using the Tobacco Use Supplement to the Current Population Survey, Zhu et al. reported a higher overall population quit rate (5.6%) in 2014–15 compared to all other years (2001–02, 2003, 2006–07, 2010–11; range = 4.3–4.5%) and a higher prevalence of quit attempts and quit successes in 2014–15 among past-year e-cigarette users compared to non-users 5. Using the National Health Interview Survey (NHIS), Delnevo and colleagues reported a strong correlation between daily e-cigarette use and recent smoking cessation, specifically during the time-frame that e-cigarettes were available on the market 6, 7. More recent data from NHIS support significant increases in quit attempts, recent cessation and the population quit ratio from 2009–18, with a significant increase in adult e-cigarette use from 2017 to 2018 8. These studies, together with population-level studies on the relationships between frequency of use and device type with smoking cessation 9, 10, and more recent data from randomized controlled trials 11, underscore how triangulating findings across person, time, place and design can improve our understanding of the impact of e-cigarettes on smoking cessation. Importantly, these studies also harken to earlier work on the importance of boosting quit attempts to improve population smoking cessation 12. At this point, we are a decade into research on e-cigarettes and key questions remain on their public health impact, especially in places where regulation has lagged behind an expanding market. 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