Young people aged 15-24 have experienced the greatest percentage increase in opioid overdose deaths in recent years. Yet the same age group is often resistant to the influence of public health campaigns.

The effectiveness of ad campaigns targeting young adults depends on a wide range of factors, said Xiaoxia Cao, an associate professor of communication who conducts health communication research with an emphasis on anti-prescription opioid campaigns. The audience’s experience with prescription opioids and the way that information about the dangers of prescription opioids is delivered both matter for the campaigns’ success, she said.

In her last two publications, Cao zeroed in on the emotional and psychological factors that affect the effectiveness of anti-drug messages. Here she discusses some of her findings.

You advocate customizing the message for subgroups of the audience. Tell us about that.

My research showed that some anti-drug messages are more likely to be successful for certain groups of people.

In my latest study, some participants had little experience of misusing prescription opioids whereas others had some experience. I noticed that the messages being tested worked very well with people who had little or no misuse experience. However, they were not as effective with people who had some misuse experience.

So, the bigger challenge is to convince people who are already on the path of misuse to turn around. Researchers need to continue exploring campaign strategies that may work for people already addictive to the drugs. Interventions beyond communication campaigns such as government regulations of prescription opioid access and fundings for rehabilitation programs are also needed.

You’ve said that a message that arouses fear by emphasizing the risks of opioid misuse isn’t always effective with young people. Why?

Whether fear appeals lead to desired changes in the audience’s attitudes and behavior depends on several factors. According to existing research, when people receive messages about risks of opioid misuse, they will first evaluate the severity of the risks and their vulnerability to them. If they think that the risks are severe and they are vulnerable to them, fear may be effective.  If they don’t think the risks are severe or don’t think they are vulnerable, no fear will be aroused, and the messages will have no impact.

Even if the message arouses fear, people will comply with the recommendation only if they think that the recommendation will effectively address the fear – and they have confidence in their own ability to follow through the recommendation. So, the message success comes with a lot of “ifs.”

What psychological aspects should be considered in this kind of messaging?

I’ll explain two – anticipated guilt and psychological reactance. Normal guilt occurs when people violate certain standards they want to uphold. Anticipated guilt is the guilt you feel when just thinking about such violations, such as causing harms or distress in other people.

There’s research showing that when people anticipate that their action will make them feel guilty, they will avoid the action. Appealing to anticipated guilt is more effective than appealing to reactive guilt, which is experienced after violations have occurred. It is because people who experience anticipated guilt have done no harm yet, and still can avoid the behavior that would result in reactive guilt.

My research also suggests that anti-drug messages that appeal to anticipated guilt are less likely to induce “psychological reactance” from the audience. Psychological reactance is a combination of negative cognitive and emotional reactions that result from the perception of restricted freedom. When experiencing psychological reactance, people rebel against the recommendation of a message. When experiencing anticipated guilt, people feel they are still in control and people can still decide what to do.

What are some other insights into the tactics of persuasion that you have found?

Existing research suggests that telling stories about the risks of misusing opioids has the persuasive power that we don’t normally see in messages that simply present arguments or factual evidence. My research explores story features that can further advance the persuasive power of stories.

In one of my studies I showed that first-person internally focused narratives – that is, stories with a character in first person revealing their feelings, thoughts and motivations – heightened perceived dangers of prescription opioids, aroused anticipated guilt and promoted negative attitudes toward prescription opioids among the audience.