{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:59:13Z","timestamp":1790359153423,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"clinicaltrials.gov","award":["NCT04524533"],"award-info":[{"award-number":["NCT04524533"]}]},{"name":"National Institute of Dental and Craniofacial Research at the National Institutes of Health","award":["UH3DE028866"],"award-info":[{"award-number":["UH3DE028866"]}],"id":[{"id":"https:\/\/ror.org\/004a2wv92","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Text messaging programs are effective for smoking cessation. Unprompted, participant-initiated text messages that are unrecognized by rules-based programs (UNRs) provide real-time reactions and feedback regarding program experiences. This mixed methods study characterizes UNRs and examines their prospective relationship with treatment outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a secondary analysis of a randomized controlled cessation induction trial with adult smokers in a 4-week text message program. UNRs were defined as participant-initiated text messages not matching pre-defined expected responses or not in answer to pre-programmed queries. UNRs were qualitatively coded (if not related to a study payment issue or question) and analyzed for associations with participant and program characteristics as well as outcomes (use of evidence-based treatments [EBTs] for cessation and 7-day point prevalence abstinence from smoking).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants (n\u2009=\u2009440; mean age\u2009=\u200947.5, 47.4% female, 16.9% motivated to quit) sent 2264 UNRs (1785 met criteria for coding) and 59.8% sent \u22651 UNR. Sending any UNR or any codable UNR predicted greater odds of EBT use during the 7-month study period (self-reported and objectively verified, all ORs\u2009&amp;gt;\u20091.50). Sending any codable UNR (OR\u2009=\u20091.91 [1.09-3.33]) or a UNR acknowledging a program-initiated text (OR\u2009=\u20092.00 [1.18-3.37]) predicted greater odds of self-reported smoking abstinence during the follow-up. Sending a UNR conveying updates on target behaviors predicted greater odds of biochemically verified abstinence during follow-up (OR\u2009=\u20093.05 [1.24-7.46]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>UNRs may serve as markers of meaningful engagement and early indicators of subsequent behavioral outcomes in text messaging programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Text messaging programs are effective for supporting smoking cessation, yet smokers\u2019 real-time unprompted text message responses have not been examined. Our qualitative and quantitative analyses revealed that smokers\u2019 text messages addressed important topics (eg, acknowledgment of intervention-delivered messages, smoking status updates). Additionally, sending messages predicted use of evidence-based cessation treatment and abstinence. Smokers\u2019 unprompted messages could indicate meaningful engagement with text messaging programs and guide intervention development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag199","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:49:23Z","timestamp":1788457763000},"source":"Crossref","is-referenced-by-count":0,"title":["Mixed methods analysis of unprompted participant text messages in an automated text message program for smoking cessation induction"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0859-796X","authenticated-orcid":false,"given":"Belinda","family":"Borrelli","sequence":"first","affiliation":[{"name":"Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9272-5513","authenticated-orcid":false,"given":"Romano","family":"Endrighi","sequence":"additional","affiliation":[{"name":"Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin N","family":"Rackoff","sequence":"additional","affiliation":[{"name":"Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline S","family":"Goodman","sequence":"additional","affiliation":[{"name":"Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston , Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J","family":"Hart","sequence":"additional","affiliation":[{"name":"Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Jurasic","sequence":"additional","affiliation":[{"name":"Center for Clinical Research, Henry M. Goldman School of Dental Medicine, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard J","family":"Cabral","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Boston University , Boston, Massachusetts, 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026092513124807300_ref1","doi-asserted-by":"publisher","first-page":"118","DOI":"10.15585\/mmwr.mm7407a3","article-title":"Notes from the field: tobacco product use among adults \u2014 United States, 2017\u20132023","volume":"74","author":"Arrazola","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026092513124807300_ref2","doi-asserted-by":"publisher","first-page":"475","DOI":"10.15585\/mmwr.mm7218a1","article-title":"Tobacco product use among adults \u2013 United States, 2021","volume":"72","author":"Cornelius","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026092513124807300_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-054948","article-title":"Disparities in current cigarette smoking among US adults, 2002\u20132016","author":"Agaku","year":"2019","journal-title":"Tob Control"},{"key":"2026092513124807300_ref4","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7329a1","article-title":"Adult smoking cessation \u2014 United States, 2022","volume":"73","author":"VanFrank","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026092513124807300_ref5","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1136\/tc-2023-058323","article-title":"Systematic review and meta-analysis of text messaging interventions to support tobacco cessation","volume":"34","author":"Puljevi\u0107","year":"2025","journal-title":"Tob Control"},{"key":"2026092513124807300_ref6","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.2196\/mhealth.5436","article-title":"Text messaging-based interventions for smoking cessation: a systematic review and meta-analysis","volume":"4","author":"Scott-Sheldon","year":"2016","journal-title":"JMIR mHealth uHealth"},{"key":"2026092513124807300_ref7","doi-asserted-by":"publisher","first-page":"CD006611","DOI":"10.1002\/14651858.CD006611.pub5","article-title":"Mobile phone text messaging and app-based interventions for smoking cessation","volume":"10","author":"Whittaker","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092513124807300_ref8","doi-asserted-by":"publisher","first-page":"107209","DOI":"10.1016\/j.ypmed.2022.107209","article-title":"Tailored text message and web intervention for smoking cessation in U.S. socioeconomically-disadvantaged young adults: a randomized controlled trial","volume":"165","author":"Villanti","year":"2022","journal-title":"Prev Med"},{"key":"2026092513124807300_ref9","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1037\/hea0001297","article-title":"Responses to a COVID-19 vaccination intervention: qualitative analysis of 17K unsolicited SMS replies","volume":"42","author":"Blazek","year":"2023","journal-title":"Health Psychol"},{"key":"2026092513124807300_ref10","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.2196\/jmir.962","article-title":"Patients\u2019 engagement with \u201csweet talk\u201d \u2013 a text messaging support system for young people with diabetes","volume":"10","author":"Franklin","year":"2008","journal-title":"J Med Internet Res"},{"key":"2026092513124807300_ref11","doi-asserted-by":"publisher","first-page":"e11175","DOI":"10.2196\/11175","article-title":"Predictors of engagement, response to follow up, and extent of alcohol reduction in users of a smartphone app (drink less): secondary analysis of a factorial randomized controlled trial","volume":"6","author":"Garnett","year":"2018","journal-title":"JMIR mHealth and uHealth"},{"key":"2026092513124807300_ref12","doi-asserted-by":"publisher","first-page":"107332","DOI":"10.1016\/j.addbeh.2022.107332","article-title":"The effect of race\/ethnicity and adversities on smoking cessation among U.S. adult smokers","volume":"131","author":"Avila","year":"2022","journal-title":"Addict Behav"},{"key":"2026092513124807300_ref13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1940-0640-7-8","article-title":"Motivation rulers for smoking cessation: a prospective observational examination of construct and predictive validity","volume":"7","author":"Boudreaux","year":"2012","journal-title":"Addict Sci Clin Pract"},{"key":"2026092513124807300_ref14","doi-asserted-by":"publisher","first-page":"e17734","DOI":"10.2196\/17734","article-title":"Optimizing text messages to promote engagement with internet smoking cessation treatment: results from a factorial screening experiment","volume":"22","author":"Graham","year":"2020","journal-title":"J Med Internet Res"},{"key":"2026092513124807300_ref15","doi-asserted-by":"publisher","first-page":"e2417796","DOI":"10.1001\/jamanetworkopen.2024.17796","article-title":"Engagement with a mobile chat-based intervention for smoking cessation: a secondary analysis of a randomized clinical trial","volume":"7","author":"Li","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026092513124807300_ref16","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1037\/adb0000720","article-title":"Differential mechanisms of change in motivational interviewing versus health education for smoking cessation induction","volume":"35","author":"Catley","year":"2021","journal-title":"Psychol Addict Behav"},{"key":"2026092513124807300_ref17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1080\/10826084.2016.1212892","article-title":"Relational skills and client language predict outcome in smoking cessation treatment","volume":"52","author":"Lindqvist","year":"2017","journal-title":"Subst Use Misuse"},{"key":"2026092513124807300_ref18","doi-asserted-by":"publisher","first-page":"Article 1074","DOI":"10.1186\/s12889-022-13427-y","article-title":"A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial","volume":"22","author":"Borrelli","year":"2022","journal-title":"BMC Public Health"},{"key":"2026092513124807300_ref19","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1111\/j.1360-0443.1991.tb01879.x","article-title":"The Fagerstr\u00f6m test for nicotine dependence: a revision of the Fagerstr\u00f6m tolerance questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Br J Addict"},{"key":"2026092513124807300_ref20","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1037\/a0031577","article-title":"Methods used to quit smoking by people with physical disabilities","volume":"58","author":"Borrelli","year":"2013","journal-title":"Rehabil Psychol"},{"key":"2026092513124807300_ref21","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1001\/jama.2020.25019","article-title":"Interventions for tobacco smoking cessation in adults, including pregnant persons: US preventive services task force recommendation statement","volume":"325","author":"US Preventive Services Task Force","year":"2021","journal-title":"JAMA."},{"key":"2026092513124807300_ref22","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1093\/ntr\/ntz110","article-title":"Defining and measuring abstinence in clinical trials of smoking cessation interventions: an updated review","volume":"22","author":"Piper","year":"2020","journal-title":"Nicotine Tob Res"},{"key":"2026092513124807300_ref23","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1080\/14622200210123581","article-title":"Biochemical verification of tobacco use and cessation","volume":"4","author":"Benowitz","year":"2002","journal-title":"Nicotine Tob Res"},{"key":"2026092513124807300_ref24","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2025"},{"key":"2026092513124807300_ref25","doi-asserted-by":"publisher","first-page":"S112","DOI":"10.1016\/j.amepre.2007.01.022","article-title":"The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART)","volume":"32","author":"Collins","year":"2007","journal-title":"Am J Prev Med"},{"key":"2026092513124807300_ref26","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1007\/s13142-016-0453-1","article-title":"Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis","volume":"7","author":"Perski","year":"2017","journal-title":"Behav Med Pract Policy Res"},{"key":"2026092513124807300_ref27","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1038\/s41746-025-01778-w","article-title":"Engagement and attrition in digital mental health: current challenges and potential solutions","volume":"8","author":"Smith","year":"2025","journal-title":"npj Digit Med"},{"key":"2026092513124807300_ref28","doi-asserted-by":"publisher","first-page":"S172","DOI":"10.1016\/j.amepre.2020.08.008","article-title":"Using digital technologies to reach tobacco users who want to quit: evidence from the National Cancer Institute\u2019s smokefree.gov initiative","volume":"60","author":"Prutzman","year":"2021","journal-title":"Am J Prev Med"}],"container-title":["Nicotine &amp; Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag199\/70948068\/ntag199.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag199\/70948068\/ntag199.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag199\/70948068\/ntag199.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:12:54Z","timestamp":1790356374000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article\/doi\/10.1093\/ntr\/ntag199\/8785058"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":28,"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntag199","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"ntag199"}}