Seeing is Believing: The Impacts of Visual Exemplars on American Young Adults’ Reactions to Anti-Prescription Opioid Campaigns

Abstract

Many public health campaigns are designed to combat the opioid crisis in America. However, these campaigns are often ineffective or even counterproductive. To explore what contributes to the (in)effectiveness of these campaigns, an online experiment was conducted among a convenience sample of college students to test American young adults’ reactions to four anti-prescription opioid campaign messages from local and national health organizations that vary in the presence of visual exemplars and statistical information. The study found that including a visual exemplar showing the negative consequences of misusing prescription opioids increased perceived susceptibility, psychological reactance, and perceived campaign effectiveness. The impacts of visual exemplars on psychological reactance and perceived campaign effectiveness were moderated by statistical information and (partially) explained by the believability of the campaigns.

Keywords

visual exemplars statistical information perceived susceptibility psychological reactance campaign effectiveness anti-prescription opioid campaigns

The misuse of prescription opioids is a serious national crisis in America with devastating consequences (National Institute on Drug Abuse [NIDA], 2019). The misuse rate is the highest among young people between the ages of 18 and 25 (Cutler & Kremer, 2017). To combat this crisis, the government turns to public health campaigns to stop people, especially children and young people, from taking prescription opioids (Austin & Humphreys, 2017). However, past antidrug campaigns have often been ineffective or even counterproductive (Austin & Humphreys, 2017). Hence, it is important to explore what contributes to the (in)effectiveness of anti-prescription opioid campaigns.

To dissuade people from taking prescription opioids, many campaigns utilize visual exemplars and/or statistical information that highlight the negative consequences of misusing prescription opioids such as the Rx Awareness campaign by the Centers for Disease Control and Prevention (CDC, 2017). Exemplars are illustrative cases (e.g., a person/event) presented verbally and/or visually to represent typical characteristics of a phenomenon (Zillmann & Brosius, 2000). Statistical information refers to some degree of quantification of the issue under discussion (e.g., addiction rate; Gibson et al., 2011).

Although people, especially young people, have become more visually oriented due to changes in the media environment, visual exemplars have not received sufficient scholarly attention (Chang, 2013). Little research has been conducted to examine how and why visual exemplars (e.g., a framed photo of a person who died of an opioid overdose) may affect reactions to antidrug campaigns.

Drawing on theories and research related to visual persuasion, exemplars, and message believability, we argue that including visual exemplars highlighting the negative consequences of prescription opioid misuse in anti-prescription opioid campaigns should increase campaign believability (defined as perceived credibility and realism of a campaign; Stephenson et al., 2010) because visual images look closer to reality than words and are able to elicit mental imagery similar to direct experiences. The increase in campaign believability then promotes positive reactions to the campaigns. Moreover, this study explores whether statistical information moderates the impacts of visual exemplars on reactions to the campaigns. Its findings improve our understanding of the impacts of visual exemplars on young Americans’ reactions to anti-prescription opioid campaigns, shed light on a previously untested mechanism underlying the influence of visual exemplars (i.e., campaign believability), and provide guidance for campaign design.

The Effectiveness of Antidrug Campaigns

Although public health campaigns have been used to combat the drug problem in the United States, these campaigns are often ineffective or even counterproductive (Austin & Humphreys, 2017). For example, a review of studies on the effectiveness of 12 antidrug campaigns found that two of them increased drug use, eight had no impacts, and four had positive impacts (Allara et al., 2015). One of the reasons for the ineffectiveness of antidrug campaigns is that some campaigns portray the consequences of drug use unrealistically (Schneider, 2012). One way to address this problem may be to include visual exemplars that illustrate the consequences because visual images tend to look natural and close to reality (Messaris & Abraham, 2001). Hence, this study tests whether visual exemplars may affect responses to anti-prescription opioid campaigns through shaping the believability of such campaigns.

Impacts of Visual Exemplars on Reactions to Anti-Prescription Opioid Campaigns

Three possible outcome variables that may be affected by anti-prescription opioid campaigns—perceived susceptibility, psychological reactance, and perceived campaign effectiveness—are tested in this study due to their ability to influence recommendation compliance. Perceived susceptibility (i.e., the perceived likelihood that oneself and others that one knows are to develop a certain condition) is an important positive predictor of recommendation compliance (Ahn, 2018; Chen & Yang, 2015). Psychological reactance refers to the negative thoughts and anger that individuals have when their autonomy and freedom are threatened (Bessarabova et al., 2017; Gardner & Leshner, 2016); it often motivates individuals to restore their autonomy by defying campaign recommendations. Perceived campaign effectiveness, a strong positive predictor of actual campaign effectiveness, reflects the target audience's judgment of the persuasive potential of campaigns (Dillard et al., 2007; Dillard & Peck, 2000). According to theories and research on visual persuasion (Klepacz et al., 2016; Messaris & Abraham, 2001), exemplars (Zillmann, 2006; Zillmann & Brosius, 2000) and message believability (Byrne et al., 2012; Cho & Choi, 2010; Pinkleton et al., 2010; So & Nabi, 2013), including visual exemplars in anti-prescription opioid campaigns may increase perceived susceptibility, reduce psychological reactance, and increase perceived campaign effectiveness by affecting campaign believability.

Visual Exemplars and Campaign Believability

The ability of visual exemplars to enhance campaign believability resides partly in the distinctive properties of photographs such as their analogical quality and indexicality (Messaris & Abraham, 2001). The analogical quality refers to the fact that images are linked to their meaning by their resemblance to the objects they represent, which enables images to look more natural and closer to reality than words. The indexicality of photographs sets them apart from other types of images. It refers to the fact that photographs are considered more authentic representations of reality than other types of images (e.g., drawings), which makes viewers less inclined to question what they see in photographs (Klepacz et al., 2016). As a result, people tend to believe what they see in photographs and overlook the fact that all images (including photographs) are artificial constructions used to convey certain ideas. Moreover, images can elicit mental imagery that resembles real experiences (Cameron & Chan, 2008; Chang, 2013; Mani & MacInnis, 2003), which further increases believability of the images and, therefore, the campaign messages they convey. Hence, we hypothesize that including visual exemplars in anti-prescription opioid campaigns increases campaign believability (H1).

Visual Exemplars and Perceived Susceptibility

Exemplars—visual exemplars in particular—can increase risk perception (Gibson & Zillmann, 2000; Jain et al., 2017). According to exemplification theory (Zillmann & Brosius, 2000), individuals often rely on exemplars to draw inferences about a topic because exemplars are usually emotionally arousing and, therefore, easily accessible for exerting disproportionate influence on one's judgment (Dixon, 2016; Yoo, 2016; Zillmann, 2006).

More importantly, visual exemplars can provide concrete and realistic representation of the consequences of health behavior (Ahn, 2018; Chang, 2013; Zillmann, 2006). Such representation allows individuals to see the consequences with their own eyes, leading to increased believability of the outcomes and, therefore, heightened risk perception. Indeed, research found that realistic media messages increase personal risk perception (Pinkleton et al., 2010; So & Nabi, 2013) and that the impact of visual exemplars on social judgments may be explained by their believability (Busselle, 2001). Thus, we predict that including visual exemplars in anti-prescription opioid campaigns increases perceived susceptibility to the misuse of prescription opioids (H2a) by affecting campaign believability (H2b).

Visual Exemplars and Psychological Reactance

Visual exemplars may also reduce psychological reactance. Health campaigns with overly persuasive language and/or apparent persuasion intent often result in psychological reactance because they are perceived as manipulative and threats to one's autonomy (Bessarabova et al., 2017; Dillard & Shen, 2005; Gardner & Leshner, 2016). Visual exemplars, however, may reduce psychological reactance by lowering perceived persuasion intent and increasing campaign believability (Klepacz et al., 2016) because images invite people to construct meanings based upon contextual cues (Klepacz et al., 2016; Messaris & Abraham, 2001). As a result, people are less conscious about being presented with a set of claims when exposed to visual exemplars, more likely to accept the implicit messages conveyed and, therefore, less likely to experience psychological reactance (Shen et al., 2017). With all this in mind, we propose the hypothesis that including visual exemplars in anti-prescription opioid campaigns reduces psychological reactance (H3a) by affecting campaign believability (H3b).

Visual Exemplars and Perceived Campaign Effectiveness

Visual exemplars should also increase the perceived effectiveness of anti-prescription opioid campaigns. Research has shown that visual exemplars can increase the effectiveness of health communication (King, 2016). One relatively well-established explanation for the positive impact of exemplars on (perceived) campaign effectiveness is the emotional reactions aroused by exemplars (de Wit et al., 2008; Zebregs et al., 2015; Zillmann, 2006). However, visual exemplars may also increase perceived campaign effectiveness via enhancing campaign believability. As aforementioned, the meaning conveyed by images is usually constructed by message recipients (Klepacz et al., 2016; Messaris & Abraham, 2001). Because of it, message recipients are less likely to refute the message implied by the images and constructed by themselves (Klepacz et al., 2016; Limon & Kazoleas, 2004). Reduced counterarguments should then increase campaign believability and, therefore, perceived campaign effectiveness (Byrne et al., 2012; Cho & Choi, 2010). Thus, we hypothesize that including visual exemplars in anti-prescription opioid campaigns increases perceived campaign effectiveness (H4a) by affecting campaign believability (H4b).

The Moderating Role of Statistical Information

It is unclear how statistical information may interact with visual exemplars to influence reactions to anti-prescription opioid campaigns. Some studies have shown that, compared to exemplars alone, the combination of exemplars (in the form of narrative) and statistical information generates higher levels of risk perception (Nan et al., 2015), perceived campaign effectiveness (Allen et al., 2000) and campaign compliance (Boster et al., 2000). Others, however, have suggested that when both exemplars and statistical information are provided, people are predominantly influenced by exemplars, indicating a lack of impacts of statistical information (Boyson et al., 2015; Zillmann, 2006; Zillmann et al., 1996). Since no research has examined how visual exemplars and statistical information may interact to influence reactions to anti-prescription opioid campaigns, and to what extent the interaction effect is explained by campaign believability, we ask the questions of whether statistical information moderates the impacts of visual exemplars on perceived susceptibility (RQ1a), psychological reactance (RQ2a), and perceived campaign effectiveness (RQ3a), and whether these moderating effects are explained by campaign believability (RQ1b, RQ2b and RQ3b).

Methods

An online experiment with a two (a visual exemplar showing the negative consequences of prescription opioid misuse: present vs. absent) by two (statistical information: present vs. absent) between-subjects design was conducted in Fall 2018 among a convenience sample of college students, an important target population of antidrug campaigns.

Messages

Four anti-prescription opioid campaign messages—from public health organizations—that varied in the presence of visual exemplars and statistical information were used to increase the generalizability of our findings to real campaigns. The control message with no exemplar or statistics is from the #ChoosePT campaign by the American Physical Therapy Association. It encourages people to ask for safe alternatives to opioid pain killers. The exemplar message comes from the #Resisttherisk campaign by the Drug Enforcement Administration. It features an infant with a tube in the nose and sensors on the chest along with a short text stating that s/he suffers from opioid withdrawal. The statistics message is part of the Rx Awareness campaign by the CDC. It says that one in four people receiving long-term prescription opioids struggles with opioid addiction and encourages people to use alternative pain management methods. The combined message is part of the #StopEverydayKillers campaign by the National Safety Council (2017). It portrays the mask of a person killed by a prescription opioid overdose along with the message that each year 22,000 Americans die of a prescription opioid overdose.

Study Participants and Procedure

Twenty percent of undergraduates majoring in communication and/or related fields (N = 222) from two American universities (one in the Midwest; the other on the East Coast) participated in the experiment for extra credit. They had a mean age of 21.58 years (SD = 2.04); 33% of them were male; 87% were White, 10% Black, 2% Asian, and 1% Native American.

Subjects answered questions measuring trait reactance, helicopter parenting, peer pressure, and need for cognition before being randomly assigned to see one of the campaign messages. Afterward, they completed a questionnaire measuring perceived susceptibility, campaign believability, perceived campaign effectiveness, psychological reactance, and demographics before receiving a debriefing.

Measures

Outcome Variables

Perceived susceptibility was measured by rating participants’ agreement (on a 7-point scale; 1 = strongly disagree; 7 = strongly agree) that prescription opioid misuse could happen to themselves, family members, or someone they know (King, 2016). The responses were averaged to create an index (M = 4.74; SD = 1.36; α = .74). The same method was used to measure and create indices for other variables.

The measure for psychological reactance (M = 3.11; SD = .96; α = .70) captured both anger and negative cognitive responses toward the campaign message (see Shen and Dillard, 2005). Perceived campaign effectiveness was assessed by three items that gauged the perceived persuasive potential of the campaign message (Ju & Park, 2020) such as “this ad was persuasive” and “this ad was convincing” (M = 4.50; SD = 1.39; α = .88).

Mediator

Campaign believability was gauged by rating participants’ agreement that the campaign was “realistic” and “believable” (M = 5.06; SD = 1.23; r = .82; Stephenson et al., 2010).

Control Variables

Research shows that trait reactance (an individuals’ tendency to experience reactance in response to threats to freedom), helicopter parenting style (an overcontrolling parenting style that grants little autonomy to children) and peer pressure all affect risk perception and behavior associated with prescription opioid misuse(Xu & Cao, 2020). Need for cognition (an individual's tendency to engage in and enjoy thinking) is also found to influence message processing (Cacioppo et al., 1984). Hence, this study included trait reactance (measured by 11 items; M = 3.79; SD = .94; α = .84; Hong and Faedda, 1996), helicopter parenting style (five items; M = 2.47; SD = 1.17; α = .80; Padilla-Walker and Nelson, 2012), peer pressure (six items; M = 2.86; SD = 1.26; α = .86; Santor et al., 2000), and need for cognition (four items; M = 5.07; SD = .94; α = .65; Cacioppo et al., 1984) as control variables.

Data Analysis

The main effects of visual exemplars and the interaction effects of visual exemplars and statistical information were tested using analysis of covariance (ANCOVA). To assess the mediating role of campaign believability, PROCESS, a SPSS macro, was used (Hayes, 2013). If applicable, post hoc tests with Bonferroni correction were conducted to assess the statistical significance of differences between study conditions.

Results

Effects on Campaign Believability

Visual exemplars had a positive impact on campaign believability (F [1, 214] = 4.52, p < .05), supporting the hypothesis that including visual exemplars would increase the believability of anti-prescription opioid campaigns (H1). The impact of visual exemplars on campaign believability was moderated by statistical information (F [1, 214] = 19.76, p < .001) such that the exemplars had a significant positive impact on the believability when there was no statistical information (exemplar: M = 5.60, SD = .98; control: M = 4.51, SD = 1.14; p < .001) but had no significant impact when statistical information was provided (combined: M = 4.86, SD = 1.47; statistics: M = 5.26, SD = 1.00; p > .05; see Figure 1).

Figure 1.

The interaction effect of visual exemplars and statistical information on campaign believability.

Effects on Perceived Susceptibility

Visual exemplars also had a predicted positive impact on perceived susceptibility (F [1, 214] = 4.87, p < .05); the impact, however, was not explained by campaign believability (p > .05; see Table 1 for the results of indirect effect analysis). These findings partly supported the predictions that including visual exemplars in anti-prescription opioid campaigns would increase perceived susceptibility (H2a) by affecting campaign believability (H2b).

Table 1.

Results of Indirect Effect Analysis.

Indirect effects	Effect Size	95% BcCIs
Exemplars→ campaign believability→ susceptibility	.03	−.02, .10
Exemplars→campaign believability→ psychological reactance	−.08*	−.17, −01
Exemplars→campaign believability→perceived effectiveness	.22*	.01, .46
Exemplars × statistics→ campaign believability→ susceptibility	−.14	−.37, .04
Exemplars × statistics→campaign believability→ psychological reactance	.39*	.18, .65
Exemplars × statistics→campaign believability→perceived effectiveness	−.94*	−1.42, −.60
Direct effects
Exemplars→ susceptibility	.38*	.02, .74
Exemplars→ psychological reactance	.40*	.16, .64
Exemplars→ perceived effectiveness	.90*	.63, 1.16
Exemplars × statistics→ susceptibility	.36	−.39, 1.11
Exemplars × statistics→ psychological reactance	−.89*	−.138, −.41
Exemplars × statistics→perceived effectiveness	−.10	−.66, .45

Note. To estimate indirect effects, a bootstrapping approach (with 1,000 bootstrapped resamples) was used. Direct effects indicate the relationships between visual exemplars (or the interaction term between visual exemplars and statistical information) and the outcome variables under study while controlling for campaign believability along with trait reactance, helicopter parenting style, peer pressure, and need for cognition. 95% BcCIs refer to 95% bias-corrected confidence intervals. ^* p < .05.

Further analysis showed a nonsignificant interaction effect of visual exemplars and statistical information on perceived susceptibility (F [1, 214] = .37, p > .05) and a nonsignificant indirect effect of the interaction term on perceived susceptibility via campaign believability (p > .05). These findings answered the questions of whether statistical information would moderate the impact of visual exemplars on perceived susceptibility (RQ1a) and to what extent the moderating effect would be explained by campaign believability (RQ1b).

Effects on Psychological Reactance

Visual exemplars had an unexpected positive impact on psychological reactance (F [1, 214] = 6.74, p < .05) as well as a predicted indirect negative impact on psychological reactance via campaign believability (p < .05). These findings partly corroborated our predictions that including visual exemplars in anti-prescription opioid campaigns would reduce psychological reactance (H3a) by affecting campaign believability (H3b).

Beyond this, the impact of visual exemplars on psychological reactance was moderated by statistical information (F [1, 214] = 4.04, p < .05) such that visual exemplars significantly increased psychological reactance when statistical information was absent (exemplar: M = 3.55, SD = .98; control: M = 2.97, SD = .92; p < .01); but had no significant impact when statistical information was present (combined: M = 2.96, SD = .89; statistics: M = 2.94, SD = .93; p > .05; see Figure 2). The interaction effect was partly explained by campaign believability (p < .05). These findings addressed the questions of whether statistical information would moderate the impact of visual exemplars on psychological reactance (RQ2a) and to what extent the moderating effect could be explained by campaign believability (RQ2b).

Figure 2.

The interaction effect of visual exemplars and statistical information on psychological reactance.

Effects on Perceived Campaign Effectiveness

Visual exemplars had an anticipated positive impact on perceived campaign effectiveness (F [1, 214] = 67.56, p < .001). The positive impact was partly explained by campaign believability (p < .05). The findings supported the hypotheses that including visual exemplars in anti-prescription opioid campaigns would increase perceived campaign effectiveness (H4a) by affecting campaign believability (H4b).

Moreover, statistical information moderated the impact of visual exemplars on perceived campaign effectiveness (F [1, 214] = 9.33 p < .01) such that the exemplars significantly increased perceived campaign effectiveness when statistical information was not provided (exemplar: M = 5.34, SD = 1.02; control: M = 3.72, SD = 1.33; p < .001); but had little impact when statistical information was provided (combined: M = 4.73, SD = 1.41; statistics: M = 4.20, SD = 1.25; p > .05; see Figure 3). The interaction effect was fully explained by campaign believability (p < .05), which answered the questions of whether statistical information would moderate the impact of visual exemplars on perceived campaign effectiveness (RQ3a) and to what extent the moderating effect would be explained by campaign believability (RQ3b; see Table 2 for finding summary).

Figure 3.

The interaction effect of visual exemplars and statistical information on perceived campaign effectiveness.

Table 2.

Summary of Results.

Hypotheses/Research Questions	Findings
H1: Including visual exemplars in anti-prescription opioid campaigns increases campaign believability.	Supported
H2a: Including visual exemplars in anti-prescription opioid campaigns increases perceived susceptibility to the misuse of prescription opioids(a) through affecting campaign believability(b).	H2a supported H2a not supported
H3: Including visual exemplars in anti-prescription opioid campaigns reduces psychological reactance(a) through affecting campaign believability(b).	H3a not supported H3b supported
H4: Including visual exemplars in anti-prescription opioid campaigns increases perceived campaign effectiveness(a) through affecting campaign believability(b).	H4a supported H4b supported
RQ1: How does statistical information affect the impact of visual exemplars on perceived susceptibility?(a) Is the interaction effect explained by campaign believability?(b)	No significant direct or indirect interaction effect
RQ2: How does statistical information affect the impact of visual exemplars on psychological reactance?(a) Is the interaction effect explained by campaign believability?(b)	Significant direct and indirect interaction effects
RQ3: How does statistical information affect the impact of visual exemplars on perceived campaign effectiveness?(a) Is the interaction effect explained by campaign believability?(b)	Significant direct and indirect interaction effects

Discussion

This study investigated how and why visual exemplars (a common feature of anti-prescription opioid campaigns) may affect reactions to the campaigns among young Americans, a demographic group that suffers most from the opioid crisis (Cutler & Kremer, 2017). Moreover, this study explored whether the impacts of visual exemplars are moderated by statistical information and explained by campaign believability.

Our findings showed that including visual exemplars in anti-prescription opioid campaigns resulted in mixed reactions. It made the campaigns more believable, increased perceived susceptibility to prescription opioid misuse, and enhanced perceived campaign effectiveness. The observed positive impact of visual exemplars on campaign believability supports the argument that visual exemplars can enhance campaign believability because they look more natural and closer to reality than words (Klepacz et al., 2016; Messaris & Abraham, 2001) and are able to elicit mental imagery similar to direct experiences (Cameron & Chan, 2008; Chang, 2013; Mani & MacInnis, 2003). The positive impact of visual exemplars on perceived susceptibility corroborates the notion that visual exemplars can heighten risk perception by providing concrete, realistic, and usually emotionally arousing representation of consequences of health behavior (Ahn, 2018; Chang, 2013; Dixon, 2016; Zillmann, 2006). Furthermore, by showing a positive impact of visual exemplars on perceived campaign effectiveness, our finding lends support to the idea that visual exemplars invite message recipients to construct meaning on their own, which makes message recipients less likely to argue against the message implied by the exemplars and constructed by themselves (Klepacz et al., 2016; Limon & Kazoleas, 2004), leading to higher levels of campaign believability and, therefore, perceived campaign effectiveness (Byrne et al., 2012; Cho & Choi, 2010).

The impact of visual exemplars on psychological reactance turned out to be more complicated than predicted, however, as the exemplars had an expected indirect negative impact (via campaign believability) and a surprisingly positive direct impact on the outcome variable. The findings suggest that visual exemplars are capable of exerting opposite impacts on psychological reactance through different mechanisms. Their indirect negative impact on psychological reactance is consistent with the argument that visual exemplars can reduce psychological reactance by lowering perceived persuasion intent and increasing campaign believability because the exemplars convey campaign messages implicitly by encouraging message recipients to construct meaning themselves (Klepacz et al., 2016; Messaris & Abraham, 2001). The observed direct positive impact of visual exemplars on psychological reactance, on the other hand, suggests that the exemplars can elicit psychological reactance through mechanisms not tested here (e.g., perceived self-efficacy).

As for the moderating effect of statistical information, the presence of statistical information was found to undermine the significant impacts of visual exemplars on campaign believability, psychological reactance, and perceived campaign effectiveness. These findings supported the dual-process theories for information processing (Slovic, 2007). According to the theories, images trigger the experiential system for information processing that elicits quick, automatic, and intuitive responses from people. Statistical information, in contrast, activates the analytic system that motivates slower and more effortful processing of information and requires justification via logic and evidence. Once the analytic system is triggered, it can monitor, even override, the automatic and intuitive responses of the experiential system, which explains our findings that when statistical information (activating the analytic system) was presented, the impacts of visual exemplars (processed through the experiential system) were no longer significant. Finally, by showing that the impacts of visual exemplars and the interaction effects of the exemplars and statistical information on psychological reactance and perceived campaign effectiveness were (partly) explained by campaign believability, my findings indicate the important role played by campaign believability—a previously untested mechanism—in explaining the influence of visual exemplars.

Practical Implications

Our findings suggest that visual exemplars that emphasize the negative consequences of misusing prescription opioids are a double-edged sword. They can motivate compliance by increasing risk perception and perceived campaign effectiveness. At the same time, they can also reduce the effectiveness of campaigns by triggering psychological reactance. To harness the persuasive power of visual exemplars and minimize their ability to trigger psychological reactance, campaign designers may consider employing freedom restoration techniques (e.g., a freedom restoration postscript) when using visual exemplars (Bessarabova et al., 2017).

Limitations

Our reliance on a convenience sample of college students prevents us from generalizing our findings to American young adults; future research using a representative sample may further test the impacts of visual exemplars. Our use of four real anti-prescription opioid campaigns increased the external validity of our findings at the expense of their internal validity because we were unable to use identical campaign messages, visual exemplars, or statistical information across study conditions. To overcome this limitation and test the replicability of our findings, future studies may use fictitious campaign messages to keep the messages, exemplars, and statistical information identical across study conditions. These studies may also consider using more than one visual exemplar and/or different drug messages (e.g., cannabis) to re-examine the influence of visual exemplars and test the actual effectiveness of campaign messages.

Conclusion

Despite the limitations, this study is among the first to explore the impacts of visual exemplars on responses to anti-prescription opioid campaigns and the role of campaign believability in explaining such impacts. Its findings improve our understanding of the influence of visual exemplars and provide guidance for campaign design. Our findings also raise important questions that can be addressed by future research such as what explains the positive impact of visual exemplars on psychological reactance and to what extent the impacts of visual exemplars on reactions to anti-prescription opioid campaigns are moderated by other factors (e.g., outcome-relevant involvement; So et al., 2017).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Xiaoxia Cao

Authior Biographies

Xiaoxia Cao (PhD, University of Pennsylvania) is an associate professor in the Department of Communication at the University of Wisconsin-Milwaukee, USA. Her research interests include media effects, persuasion, health communication, political communication, strategic communication, and media psychology.

Jie Xu (PhD, University of Alabama) is an associate professor in the Department of Communication at Villanova University, USA. Her research primarily focuses on media effects, particularly the psychological and social effects of mediated messages in key strategic communication contexts.

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