2018 Vol 11 Issue 60

Iosifyan M.A., Arina G.A., Nikolaeva V.V. Tasty and nasty: affective and cognitive attitudinal ambivalence towards health among adolescents


IOSIFYAN M.A., ARINA G.A., NIKOLAEVA V.V. TASTY AND NASTY: AFFECTIVE AND COGNITIVE ATTITUDINAL AMBIVALENCE TOWARDS HEALTH AMONG ADOLESCENTS
Russian version: Иосифян М.А., Арина Г.А., Николаева В.В. Сладкий и гадкий: аффективная и когнитивная амбивалентность аттитюдов по отношению к здоровью у подростков

Lomonosov Moscow State University, Moscow, Russia

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Attitudes are positive and negative evaluations of objects. Cognitive attitudes refer to judgments about objects, while affective attitudes refer to feelings towards objects. Studying cognitive and affective attitudes is important, because they impact health behaviors. However, people’s judgments and feelings about objects are sometimes mixed, positive and negative at the same time. This phenomenon – affective and cognitive attitudinal ambivalence – plays a moderating role in attitude-behavior link. It is already known that adolescents express attitudinal ambivalence towards risky behaviors (alcohol and substance misuse) and that impacts their behaviors. In present study we investigated attitudinal ambivalence towards wider range of health-related objects: risky behaviors, healthy behaviors, family and the self. Because attitudinal ambivalence may change over the course of a lifespan, in the present study it is investigated in developmental perspective. We compared affective and cognitive attitudinal ambivalence towards health-related objects among younger (11–14 y.o.) and older adolescents (15–16 y.o.). The following differences among adolescents were found. Compared to younger adolescents, older adolescents have more contradictory affective attitudes (coexistence of positive and negative feelings towards health-related objects). They hold more ambivalent affective attitudes towards risky behaviors and family in particular. However, no differences were found in cognitive attitudinal ambivalence (coexistence of contradictory judgments about health-related objects) between the two groups of adolescents. Both groups of adolescents have more contradictory feelings towards health-related objects, compared to contradictory judgments about these objects. Practical applications of these findings in preventive programs for healthy lifestyle are discussed.

Keywords: attitudes, attitudinal ambivalence,cognitive ambivalence, affective ambivalence, health, adolescents

 

Attitudes refer to positive or negative evaluations of certain objects. Attitudes have a significant impact on our behaviors. For example, consumer and environmental attitudes impact consumer behavior [Panzone et al., 2016; Sörqvist et al., 2013], political attitudes impact voting behavior [Wang, 2016], violence-related attitudes impact antisocial behaviors [Intravia et al., 2016]. Attitudes play a role in health behaviors as well [Conner et al., 2011; Kiviniemi et al., 2007; Lawton et al., 2009].

Firstly, attitudes impact health behaviors directly. Researchers found that cognitive attitudes (judgments about health-related objects) and affective attitudes (feelings towards health-related objects) predict wide range of health behaviors [Lawton et al., 2007; Lawton et al., 2009]. Secondly, attitudes impact health behaviors indirectly. They play a mediating role between different variables (e.g., values, social norms) and health behaviors [Iosifyan et al., 2015; Maio, Olsen, 1994; Stok et al., 2014].

Traditionally, it is considered that attitudes are unidimensional: positive or negative. This is related to the choice of methods used to measure cognitive / affective attitudes. For example, cognitive attitudes are often measured with semantic differential scales [Fishbein, Ajzen, 1975; Lawton et al., 2009]. During this evaluation, the participant rates a health-related object or behavior (for example, smoking) as beneficial or harmful. To measure affective attitudes researchers also use semantic scales or Implicit Association Test to determine whether an object or behavior is pleasant or unpleasant [Greenwald et al., 1998; Huijding et al., 2005; Weck, Höfling, 2015]. However, people’s cognitive attitudes towards an object can be mixed (e.g., beneficial and harmful), as well as affective ones (e.g., pleasant and unpleasant). For instance, a person can consider that drinking alcohol is harmful to health, but beneficial to cope with stress.

To address this phenomenon, researchers refer to attitudinal ambivalence [Jonas et al., 2000; Scott, 1968]. Affective attitudinal ambivalence is a simultaneous existence of positive and negative feelings towards an object, while cognitive attitudinal ambivalence is a simultaneous existence of positive and negative judgments about an object. People have ambivalent attitudes towards such health-related objects as eating, smoking, and marijuana use [Armitage et al., 2003; Wilson et al., 2013; Zhao, Capella, 2008]. Attitudinal ambivalence is important, firstly, because it has a moderating effect on the attitude-behavior link [Conner et al., 2003; Cooke, Sheeran, 2004; Hohman et al., 2014]. For example, it was found that if attitudinal ambivalence is low, attitudes towards low-fat diet predict health behaviors. But in the case of high attitudinal ambivalence towards low-fat diet, attitude-behavior relationship is significantly weaker [Conner et al., 2002]. Secondly, attitudinal ambivalence is important for prevention programs aiming to change health related attitudes, because ambivalent attitudes are more easily changed by the means of persuasion, compared to non-ambivalent attitudes [Armitage, Conner, 2000].

Despite these findings, attitudinal ambivalence has received little attention from health researchers [Conner, Armitage, 2008; Hohman et al., 2014]. In present study we contribute to the research of attitudinal ambivalence by investigating it in a developmental perspective. Previous studies rarely considered developmental changes in ambivalent feelings and thoughts towards health. During adolescence, ambivalence in feelings and judgments is pronounced [Tighe, Birditt, 2016]. Moreover, neuro correlates which enable simultaneous activation of affective negativity and positivity are more developed in older children compared to younger [Casey et al., 2005]. Behavioral experiments show that older children experience and understand mixed emotions more, compared to younger children [Zajdel et al., 2013]. Thus, it is likely that attitudinal ambivalence towards health changes during adolescents’ development.

To investigate attitudinal ambivalence towards health in a developmental perspective, in present study we compare affective and cognitive attitudinal ambivalence towards health-related objects among younger and older adolescents. Based on previous research on ambivalence, we hypothesize that older adolescents have bigger cognitive and affective attitudinal ambivalence towards health compared to younger adolescents.

Affective attitudinal ambivalence can coexist with cognitive one. For example, a person may have high affective attitudinal ambivalence towards smoking (consider it as pleasant and unpleasant). At the same time, that person may have cognitive attitudinal ambivalence towards smoking (consider it beneficial and harmful). Attitudinal ambivalence towards health is related to development of emotional and cognitive complexity – abilities to integrate both positive and negative feelings and thoughts. Cognitive-affective developmental theory supposes that cognitive complexity, increasing with age, leads to the development of emotional complexity [Labouvie-Vief, 2003]. In present study we test if cognitive and affective attitudinal ambivalences towards health are concordant (e.g., both cognitive and affective attitudinal ambivalence are high or both are low).

Previous studies on attitudinal ambivalence among adolescents were concentrated on its role in risky behaviors, attitudes, and norms [Conner et al., 2003; Hohman et al., 2014; Priester, 2002; Zhao, Capella, 2008]. It was found that adolescents with high attitudinal ambivalence reduce it by orienting on group norms (e.g., friends; Hohman et al., 2014]. The practical implication of attitudinal ambivalence phenomena for health behaviors was also studied. It was found that high-risk adolescents with ambivalent attitudes can be more easily persuaded, compared to adolescents with non-ambivalent attitudes [Zhao, Capella, 2008]. However, most of these studies investigated ambivalent attitudes towards substance, alcohol, and marijuana misuse. It is possible that ambivalence exists towards other health related factors. Thus, in our study we investigate ambivalent attitudes towards a wide range of objects related to health: risky behaviors, healthy behaviors, family and the self.

Method

Sample

79 adolescents participated in the study (35 males, age range 11–16, Mage = 14,34, SD = 1,21). All adolescents were recruited at school as volunteers to participate in the study. Informed consent was obtained. Only those adolescents who were healthy (did not have any chronic health conditions and mental disorders) according to the self-report and medical cards, participated in the study. This study has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki).

Procedure

We measured attitudinal ambivalence towards the following objects: healthy behaviors (sports, hygiene, daily regimen, visiting doctors), risky behaviors (smoking, drugs and alcohol misuse), family and the self (me). For further analysis of attitudinal ambivalence, we averaged three objects related to risky behaviors. We did not average objects related to healthy behaviors, because these objects are less investigated in the literature, compared to risky behaviors [Conner et al., 2003; Hohman et al., 2014; Priester, 2002; Zhao, Capella, 2008].

To measure cognitive ambivalence towards these factors, we used an approach in which an object is scored as harmful and as beneficial on two separate scales [Newby-Clarck et al., 2008]. We first asked our participants to estimate negative impact of nine objects on their health (sports, hygiene, etc.) on a scale from 1 to 10 (1 – not at all, 10 – very strong). We next asked the participants to estimate positive impact of the same objects on a scale from 1 to 10.

To measure affective attitudinal ambivalence, we used a color test. The color test measures the strength of association between affective words and attitude objects. The procedure of this test is based on the existence of semantic / affective associations between affective words and colors. The existence of such associations is supported in vector encoding model and color perception [Kiselnikov et al., 2017; Sokolov, 2000]. It might also be linked to the phenomena of cross-modal associations mediated by semantic / affective representations [Etzi et al., 2016; Palmer et al., 2013]. In present study we asked our participants to rank 8 colors from Lüscher’s color test from best to least as they relate to 9 objects related to health (sports, family, etc.), and as they relate to 3 positive words (happiness, attractiveness, positive emotions) and 3 negative words (guilt, shame, negative emotions).

Statistical analysis

To calculate cognitive attitudinal ambivalence, the Griffin’s formula was used [Thompson et al., 1995]:



Where A – ambivalence, x – score of an object on a scale "beneficial for health"; y – score of an object on a scale “harmful for health”. Cognitive attitudinal ambivalence is high if the same object is scored as very harmful for health on one scale and at the same time very beneficial on another.
To calculate affective attitudes towards health-related objects, we calculated the strength of associations between health-related objects and affective words in semantic space using an algorithm similar to Palmer and colleagues scoring algorithm [Palmer et al., 2013]:



Where X – strength of association between health-related object and affective word (e.g., happiness);
a, b and c – affective (e.g., happiness) rating of three colors most consistent with health-related object;
d, f and g – affective (e.g., happiness) rating of three colors least consistent with health-related object.

We next calculated the mean association between health-related objects and three positive words; as well as mean association between health-related objects and three negative words. These two scores were used to calculate the affective attitudinal ambivalence towards health-related objects with Griffin’s formula described above [Thompson et al., 1995]. Affective attitudinal ambivalence is high if the association between positive words and attitude object is strong, as well as the association between negative words and same attitude object.

The ambivalence scores were standardized on a scale from 1 to 10 (1 – no ambivalence, 10 – high ambivalence) for further analysis. We next compared cognitive attitudinal ambivalence between younger adolescents (age range 11–14, N = 28, 4 females, Mage = 12,96, SD = ,99) and older adolescents (age range 15–16, N = 51, 40 females, Mage = 15,09, SD = ,30); the same procedure for the affective ambivalence. First, we compared attitudinal ambivalence’s total scores for all health-related objects. Next, we compared them for each attitude object separately. We used Mann-Whitney U-test with Benjamini and Hochberg’s procedure for multiple comparisons and r to report the effect sizes (small ≥ ,10, medium ≥ ,30, large ≥ ,50).

Finally, we tested if there is a concordance between cognitive and affective attitudinal ambivalences in two groups of adolescents. We used Wilcoxon signed ran test with Benjamini and Hochberg’s procedure for multiple comparisons.

Results

Cognitive ambivalence between older and younger adolescents

Table 1 illustrates descriptive statistics for all study variables. Mann–Whitney U-test revealed no differences among older and younger adolescents after Benjamini and Hochberg’s procedure for multiple comparisons. Girls had more cognitive attitudinal ambivalence towards daily regimen compared to boys (Z = 3,01, p = ,003, r = ,338, medium effect size). Girls also had bigger ambivalence towards risky behaviors compared to boys (Z = 2,59, p = ,009, r = ,291, small effect size).

Affective ambivalence between older and younger adolescents

Mann–Whitney U-test revealed differences between younger and older adolescents. Older adolescents had a bigger total affective attitudinal ambivalence compared to younger adolescents (Z = 2,99, p = ,003, r = ,336, medium effect).

Older adolescents had larger affective attitudinal ambivalence towards risky behaviors compared to younger adolescents (Z = 3,66, p = ,0002, r = ,412, medium effect). Older adolescents also had larger affective ambivalence towards family compared to younger adolescents (= 2,76, p = ,006, r = ,311, medium effect). There was a similar tendency towards some other health related objects. Although, this tendency was not significant after Benjamini and Hochberg’s procedure for multiple comparisons and had a small effect size: sports (Z = 2,39, p = ,017, r = ,269), me (Z = 2,3, p = ,021, r = ,259). No differences between boys and girls were found.

Table 1
Descriptive statistics (Means, SD) for all variables in two groups of adolescents

  Affective ambivalence Cognitive ambivalence
Younger Older Younger Older
Risky behaviors 3,59 (1,16) 4,74 (1,04) 2,46 (2,17) 2,03 (1,43)
Family 3,78 (1,35) 4,59 (1,06) 2,73 (2,32) 2,80 (1,75)
Sport 3,96 (1,17) 4,65 (1,05) 2,80 (2,29) 2,61 (1,89)
Daily regimen 4,59 (1,11) 4,83 (0,99) 3,08 (1,78) 2,39 (1,88)
Visiting doctors 4,69 (1,12) 5,13(0,80) 4,01(1,39) 3,89 (1,53)
Me 4,18 (1,43) 4,48 (1,10) 4,09 (3,08) 4,04 (2,90)
Hygiene 4,54 (1,12) 5,00 (0,88) 3,15 (2,24) 2,52 (1,69)
Total 4,19 (0,91) 4,83 (0,61) 3,19 (1,22) 2,89 (1,14)

Notes. Score 1 indicates low ambivalence, score 10 indicates high ambivalence.

Concordance of affective and cognitive attitudinal ambivalence among younger adolescents

Wilcoxon signed rank test revealed differences between cognitive and affective attitudinal ambivalences among younger adolescents. Affective attitudinal ambivalence was greater compared to cognitive one towards following objects: risky behaviors (Z = 2,91, p = ,004, = ,389, medium effect); sports (Z = 2,59, p = ,009, r = ,346, medium effect), daily regimen (Z = 3,13, p = ,002, r= ,418, medium effect), hygiene (Z = 2,64, p = ,008, r = ,353, medium effect).

Concordance of affective and cognitive attitudinal ambivalence among older adolescents

Similarly, among older adolescents, affective attitudinal ambivalence was greater compared to the cognitive one towards the following objects: risky behaviors (Z = 6,11, p < ,0001, r = ,605, large effect), family (Z = 4,82, p < ,0001, = ,477, medium effect), sports (Z = 5,15, p < ,0001, r = ,509, large effect), daily regimen (Z = 5,72, p < ,0001, r = ,566, large effect), hygiene (Z = 5,74, p < ,0001, = ,568, large effect) and visiting doctors (Z = 4,47, p < ,0001, r = ,442, medium effect).

Discussion

In present study we investigated affective and cognitive ambivalence towards health-related objects among younger and older adolescents. We hypothesized that affective and cognitive ambivalence is bigger with age. This hypothesis was partially supported. Indeed, affective attitudinal ambivalence towards health-related objects is bigger among older adolescents compared to younger adolescents. That means that younger adolescents, as a rule, have non-contradictory affective attitudes towards health-related objects. While older adolescents experience more ambivalence in their affective attitudes towards these objects. Thus, affective attitudinal ambivalence towards health probably changes during adolescence. This result is in line with previous research on ambivalence in developmental perspective: older adolescents experience more mixed emotions [Tighe, Birditt, 2016; Zajdel et al., 2013].

The present study showed affective attitudinal ambivalence was bigger with age towards not all health-related objects, but towards risky behaviors and family. In particular, older adolescents in our study experienced more affective ambivalence towards risky behaviors compared to younger adolescents. A more ambivalent attitude towards risky behaviors among adolescents was also reported in literature. Adolescents hold both positive and negative attitudes towards marijuana and drug misuse [Armitage, Conner, 2000; Hohman et al., 2014; Zhao, 2005].

The bigger affective attitudinal ambivalence towards family among older adolescents compared to younger adolescents can be related to parent-child relationships change. In comparison with younger children, older children are characterized by novel desires for independence, taking more responsibility for themselves (e.g., for their health) and orienting on group norms. This may lead to coexistence of negative and positive feelings towards parents. Researchers report that adolescents’ ambivalence towards parents is greater compared to young adults [Tighe, Birditt, 2016]. This might explain greater attitudinal ambivalence towards family among older adolescents.

However, despite these findings, our hypothesis that cognitive attitudinal ambivalence is bigger with age was not fully supported. We would expect that cognitive complexity - thus the capacity to hold ambivalent judgments about objects – is bigger among older adolescents compared to younger ones. However, there were no significant differences in cognitive attitudinal ambivalence between these adolescents. There are two possible explanations of this fact. First, cognitive attitudinal ambivalence does not change during the period of adolescence. Second, it is possible that differences in cognitive attitudinal ambivalence exist between older and younger adolescents, but they are not as pronounced as differences in affective attitudinal ambivalence. Thus, a bigger sample size is needed to detect them.

We also tested if affective and cognitive attitudinal ambivalences coincide with each other (if there is a cognitive ambivalence towards health-related object, there is also affective ambivalence towards that object). We found that they do not necessarily coincide: affective attitudinal ambivalence was greater than cognitive one in both groups of adolescents. Particularly, it was greater among older adolescents, as the effect size was large compared to the medium effect size among younger ones. It means that adolescents have feelings with opposite valences towards health-related objects (e.g., consider risky behaviors as pleasant and unpleasant at the same time), while their judgments about these objects are less ambivalent (e.g., consider risky behaviors as harmful and non-beneficial).

There are two possible explanations of the incongruency between affective and cognitive attitudinal ambivalence. Firstly, cognitive attitudes about what is beneficial and harmful develop and become noncontradictory faster, compared to affective attitudes. Affective attitudes and evaluations are still developing and reflect the developmental peculiarities of older adolescents (desire for independence, taking more responsibility for themselves, importance of group norms).

Secondly, there is a methodological aspect which might explain why affective attitudinal ambivalence was greater than the cognitive one. Cognitive attitudinal ambivalence was measured explicitly, while affective attitudinal ambivalence: implicitly. We did not ask our participants explicitly about their affective attitude toward health-related objects. We asked them to associate colors with them. Thus, it is possible that implicit, unconscious attitudinal ambivalence is greater compared to explicit, conscious one among adolescents. Moreover, the non-concordance between implicit and explicit attitudes towards health was extensively reported in the literature [Calitri et al., 2008; Greenwald et al., 2009; Rudman et al., 2007; Sheeran et al., 2013; Wiers et al., 2002]. However, to test this hypothesis, further studies may compare explicit and implicit affective attitudinal ambivalence.

Such a pattern of non-concordance between affective and cognitive attitudinal ambivalence is preserved towards both risky / healthy behaviors’ objects and family, but not towards the self. Cognitive and affective self-ambivalence towards health are concordant. High cognitive self-ambivalence is combined with high affective self-ambivalence and vice versa. This might postulate that adolescents with self-ambivalence are consciously aware of it. The absence of discrepancies between implicit and explicit attitudes towards self is related to better health outcomes [Schröder‐Abé et al., 2007].

The findings of the present study have some practical implications. The study did not investigate the influence of attitudinal ambivalence on adolescent’s health behaviors. However, numerous researchers found that attitudinal ambivalence has an impact on adolescents’ health behaviors and risky behaviors in particular [Hohman et al., 2014; Zhao, Capella, 2008]. Thus, we suppose that our findings in attitudinal ambivalence can be used in preventive programs for a healthy lifestyle. Such programs often aim to influence adolescents’ attitudes towards health. It should be taken into account that older adolescents have more ambivalent affective attitudes towards health, particularly, towards risky behaviors. More ambivalent attitudes are potential targets for interventions, because ambivalent attitudes are more vulnerable for persuasion compared to non-ambivalent attitudes [Zhao, Capella, 2008]. Thus, campaigns for older adolescents may target affective attitudinal ambivalence in their messages rather than cognitive one. These messages may contain information about pleasant / unpleasant aspects of health-related objects (e.g., sports, risky behaviors), rather than information about harmfulness / usefulness of these objects.

There are also some suggestions for future research. The mean levels of affective and cognitive attitudinal ambivalence in our study were low. Studying low attitudinal ambivalence is important, because such ambivalence enhances the strength of attitude-behavior links [Crano, Prislin, 2006]. However, future studies may investigate adolescents with potentially higher level of attitudinal ambivalence. Some researchers assume that value conflicts are the origin of ambivalence [Katz, Hass, 1988]. Craig and colleagues [2005] found that attitudinal ambivalence about gay rights is related to value conflict. Consequently, adolescents with value conflicts (e.g., openness to change and stimulation values vs security and health values) may experience high level of attitudinal ambivalence towards health. Future studies may investigate if differences in attitudinal ambivalence towards health between younger and older adolescents are related to their value preferences.

There are some important limitations in present study to consider. Firstly, the sample size (especially the sample size of younger adolescents) was small. Future studies with bigger sample size are needed in this domain. Secondly, in present study we had different proportions of girls and boys in both groups of adolescents. It is known that girls exceed boys in mixed emotions experience and comprehension, which can be related to affective attitudinal ambivalence [Larsen el al., 2007]. However, gender probably had no impact on our main finding, because there were no significant differences between boys and girls in affective attitudinal ambivalence in our sample.

In conclusion, in present study we found that older adolescents have more contradictory affective attitudes towards health-related objects, compared to younger adolescents. Particularly, they hold more ambivalent affective attitudes towards risky behaviors and family. Contrary to affective attitudinal ambivalence, cognitive attitudinal ambivalence does not differ among older and younger adolescents. Both groups of adolescents have more contradictory feelings towards health-related objects, compared to less contradictory judgments about these objects. This fact might be related to more pronounced implicit than explicit ambivalence.


Acknowledgments
The authors thank Alena Ryabova for her assistance in data collection.


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Received 5 June 2018. Date of publication: 27 August 2018.

About authors

Iosifyan Marina A. Ph.D., Research Associate, Department of Neuro- and Pathopsychology, Faculty of Psychology, Lomonosov Moscow State University, ul. Mokhovaya, 11-9, 125009 Moscow, Russia.
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Arina Galina A. Senior Lecturer, Department of Neuro- and Pathopsychology, Faculty of Psychology, Lomonosov Moscow State University, ul. Mokhovaya, 11-9, 125009 Moscow, Russia.
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Nikolaeva Valentina V. Ph.D., Professor, Department of Neuro- and Pathopsychology, Faculty of Psychology, Lomonosov Moscow State University, ul. Mokhovaya, 11-9, 125009 Moscow, Russia.

Suggested citation

Iosifyan M.A., Arina G.A., Nikolaeva V.V. Tasty and nasty: affective and cognitive attitudinal ambivalence towards health among adolescents. Psikhologicheskie Issledovaniya, 2018, Vol. 11, No. 60, p. 1. http://psystudy.ru (in English, abstr. in Russian).

Permanent URL: http://psystudy.ru/index.php/eng/2018v11n60e/1607-iosifyan60e.html

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