Julie S Armin

Interests

Teaching

Health disparities; Structural competence in health care; social inequity and health effects

Research

Access to cancer care for socially and economically marginalized patients.

Courses

Scholarly Contributions

Books

• Armin, J. S., Burke, N. J., & Eichelberger, L. (2019). Negotiating Structural Vulnerability in Cancer Control. Albuquerque/Santa Fe: University of New Mexico/School for Advanced Research Press.

Chapters

• Armin, J. S. (2019). Bringing the People into Policy: Managing Cancer among Structurally Vulnerable Women. In Negotiating Structural Vulnerability in Cancer Control. Albuquerque/ Santa Fe: University of New Mexico/School for Advanced Research Press.
• Nancy, B. J., Armin, J. S., & Eichelberger, L. (2019). Introduction: Framing Cancer and Structural Vulnerability. In Negotiating Structural Vulnerability in Cancer Control: Contemporary Challenges for Applied Anthropology.
• Armin, J. S. (2015). Managing Borders, Bodies, and Cancer: Documents and the Creation of Subjects. In Anthropologies of Cancer in Transnational Worlds, Holly F. Mathews, Nancy J. Burke, and Eirini Kampriani, eds.(pp 86-103). New York: Routledge.

Journals/Publications

• Armin, J. (2019). Administrative (in)Visibility of Patient Structural Vulnerability and the Hierarchy of Moral Distress among Health Care Staff. Medical anthropology quarterly.
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  Public programs such as Medicaid offer highly circumscribed access to health care for low-income patients in the United States. This article describes the work of a variety of health care staff who manage specialized cancer care for publicly insured patients who have difficulty gaining or maintaining program eligibility or for uninsured and undocumented patients who are excluded from state programs. I highlight the moral distress that occurs when clinic employees become individually responsible for reconciling policies that limit patients' access to care. I conclude that responsibility for securing access to cancer care for structurally vulnerable patients frequently falls to safety net clinics and that patients' financial constraints are visible to particular types of staff, such as non-licensed health care staff and non-physician providers, who may experience this distress disproportionately. [cancer, moral distress, undocumented immigrants, public insurance, health policy] This article is protected by copyright. All rights reserved.
• Armin, J. S., Marshall, C. A., & Kroeger, S. (2019). Exploring the Experiences of University Students with a History of Cancer: A Pilot Study. JOURNAL OF CANCER EDUCATION.
• Gordon, J. S., Giacobbi, P., Armin, J. S., Nair, U. S., & Bell, M. L. (2019). Testing the feasibility of a Guided Imagery Tobacco Cessation Intervention Delivered by a Telephone Quitline: Study Protocol for a Randomized Controlled Trial. Contemporary Clinical Trials Communications, 16.
• Pettit, J. M., Ryan, A. M., Armin, J. S., & Weiss, B. D. (2019). Medical-Legal Partnerships to Enhance Residency Training in Advance Care Planning. Family Medicine, 51(4), 353-357.
• LaGrandeur, W., Armin, J. S., Howe, C. L., & Ali-Akbarian, L. (2018). Survivorship Care Plan Outcomes for Physicians, Cancer Survivors and Systems: A Scoping Review. Journal of Cancer Survivorship.
• Marshall, C. A., Curran, M. A., Brownmiller, G., Solarte, A., Armin, J., Hamann, H. A., Crist, J. D., Niemelä, M., Badger, T. A., & Weihs, K. L. (2018). Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia. Psycho-oncology, 27(10), 2405-2411.
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  Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia ("Abrazo"). Abrazo is a community-focused psychoeducational preventive intervention addressing the cancer information and coping needs of low-income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.
• Armin, J. S., Johnson, T., Hingle, M. D., Giacobbi, Jr., P., & Gordon, J. S. (2017). Development of a multi-behavioral mHealth app for women smokers. Journal of Health Communication, 22(2), 153-162.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., Roe, D., Howe, C. L., & Giacobbi, P. (2017). Development and Evaluation of the See Me Smoke-Free Multi-Behavioral mHealth App for Women Smokers. Translational Behavioral Medicine, 7(2), 172-184.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., Roe, D., Howe, C. L., & Giacobbi, P. (2017). Development and Evaluation of the See Me Smoke-Free Multi-Behavioral mHealth App for Women Smokers. Translational Behavioral Medicine.
• Gordon, J. S., Gordon, J. S., Gordon, J. S., Armin, J. S., Armin, J. S., Armin, J. S., Cunningham, J. K., Cunningham, J. K., Cunningham, J. K., Muramoto, M. L., Muramoto, M. L., Muramoto, M. L., Christiansen, S. M., Christiansen, S. M., Christiansen, S. M., Jacobs, T. A., Jacobs, T. A., & Jacobs, T. A. (2017). Lessons learned in the development and evaluation of RxCoach™, an mHealth app to increase tobacco cessation medication adherence.omen smokers.. Patient Education & Counseling, 100(4), 720-727. doi:10.1016/j.pec.2016.11.003
• Schmidt, C., Romine, J., Bell, M. L., Armin, J. S., & Gordon, J. S. (2017). User Participation and Engagement With the See Me Smoke-Free mHealth App: Prospective Feasibility Trial. JMIR Mhealth Uhealth, 5(10), e142.
• Giacobbi, P., Hingle, M., Johnson, T., Cunningham, J. K., Armin, J., & Gordon, J. S. (2016). See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity. JMIR research protocols, 5(1), e12.
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  This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors-exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions.
• Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S., & Jacobs, T. (2016). Development of RxCoach™: A theory-based mobile app to improve adherence to smoking cessation medication. Patient Education & Counseling. doi:10.1016/j.pec.2016.11.003
• Lane, T. S., Armin, J., & Gordon, J. S. (2015). Online Recruitment Methods for Web-Based and Mobile Health Studies: A Review of the Literature. Journal of medical Internet research, 17(7), e183.
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  Internet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited.
• Armin, J., Torres, C. H., Vivian, J., Vergara, C., & Shaw, S. J. (2014). Breast self-examination beliefs and practices, ethnicity, and health literacy: Implications for health education to reduce disparities. Health education journal, 73(3), 274-284.
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  This study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease.
• Orzech, K. M., Vivian, J., Huebner Torres, C., Armin, J., & Shaw, S. J. (2013). Diet and exercise adherence and practices among medically underserved patients with chronic disease: variation across four ethnic groups. Health education & behavior : the official publication of the Society for Public Health Education, 40(1), 56-66.
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  Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative (n = 71) and quantitative (n = 297) data collected in a 4-year, multimethod study among patients with hypertension and/or diabetes, the authors explored differences in self-reported adherence to diet and exercise plans and self-reported daily diet and exercise practices across four ethnic groups-Whites, Blacks, Vietnamese, and Latinos-at a primary health care center in Massachusetts. Adherence to diet and exercise plans differed across ethnic groups even after controlling for key sociodemographic variables, with Vietnamese participants reporting the highest adherence. Food and exercise options were shaped by economic constraints as well as ethnic and cultural familiarity with certain foods and types of activity. These findings indicate that health care providers should consider ethnicity and economic status together to increase effectiveness in encouraging diverse populations with chronic disease to make healthy lifestyle changes.
• Shaw, S. J., Armin, J., Torres, C. H., Orzech, K. M., & Vivian, J. (2012). Chronic disease self-management and health literacy in four ethnic groups. Journal of health communication, 17 Suppl 3, 67-81.
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  Research from several fields has explored health literacy as a multidimensional construct. The authors' multimethod study, "The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes," assessed health literacy and chronic disease self-management among 296 patients from four ethnic groups (Vietnamese, African American, White, Latino) at a Massachusetts community health center between 2006 and 2010. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) measures. Qualitative research methods, including in-depth interviews (n = 34), home visits (n = 12), chronic disease diaries (n = 15), and focus groups (n = 47), were completed with a subset of participants. Qualitative interviews indicated a wide range of interpretations of S-TOFHLA questions in which participants substituted their own illness or health care experiences for the abstract examples offered in the instrument, at times leading to incorrect responses. Situating these responses in a broader social and cultural context, this article describes examples of the wide range of chronic disease self-management abilities among participants with limited education and/or low health literacy. It also discusses the culturally variable health beliefs identified among participants interviewed that may play important roles in their chronic disease self-management practices.
• Shaw, S. J., Vivian, J., Orzech, K. M., Torres, C. H., & Armin, J. (2012). Consistency in attitudes across cancer screenings in medically underserved minority populations. Journal of cancer education : the official journal of the American Association for Cancer Education, 27(1), 165-71.
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  While a wide range of behavioral and psychosocial literature explores attitudes and beliefs towards cancer screenings, fewer studies examine attitudes across cancer screening types. We draw on quantitative and qualitative findings from a 4-year prospective study based at a community health center serving diverse, low-income patients. Methods included self-report surveys (n = 297), medical chart abstraction, and several qualitative methods with a subsample of participants. Participants included white, African-American, Vietnamese, and Latino patients who were diagnosed with diabetes, hypertension, or both. Patients' attitudes (both positive and negative) towards cancer screening types were remarkably consistent across cancer screening types. These effects were stronger among men than women. Never having had a cancer screening was generally associated with more unfavorable attitudes towards all screenings. Qualitative interviews indicate the importance of information circulated through social networks in shaping attitudes towards cancer screenings.
• Marshall, C. A., Larkey, L. K., Curran, M. A., Weihs, K. L., Badger, T. A., Armin, J., & García, F. (2011). Considerations of culture and social class for families facing cancer: the need for a new model for health promotion and psychosocial intervention. Families, systems & health : the journal of collaborative family healthcare, 29(2), 81-94.
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  Cancer is a family experience, and family members often have as much, or more, difficulty in coping with cancer as does the person diagnosed with cancer. Using both family systems and sociocultural frameworks, we call for a new model of health promotion and psychosocial intervention that builds on the current understanding that family members, as well as the individuals diagnosed with cancer, are themselves survivors of cancer. We argue that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a family's response to cancer. Likewise, acknowledging social class is necessary to understand how access to, and understanding of, otherwise available interventions for families facing cancer can be limited. Components of the model as conceptualized are discussed and provide guidance for psychosocial cancer health disparities research and the development of family-focused, strength-based, interventions.
• Shaw, S. J., & Armin, J. (2011). The ethical self-fashioning of physicians and health care systems in culturally appropriate health care. Culture, medicine and psychiatry, 35(2), 236-61.
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  Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.
• Shaw, S. J., Huebner, C., Armin, J. S., Kathryn, O., & Vivian, J. (2009). The Role of Culture in Health Literacy and Chronic Disease Screening and Management. Journal of Immigrant and Minority Health, 11(6), 531.
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  Cultural and language differences and socioeconomic status interact with and contribute to low health literacy, defined as the inability to understand or act on medical/therapeutic instructions. Health literacy is increasingly recognized as an important factor in patient compliance, cancer screening utilization, and chronic disease outcomes. Commendable efforts have been initiated by the American Medical Association and other organizations to address low health literacy among patients. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and providers that hinder communication and compliance. This review examines cultural influences on health literacy, cancer screening and chronic disease outcomes. We argue that cultural beliefs around health and illness contribute to an individual's ability to understand and act on a health care provider's instructions. This paper proposes key aspects of the intersection between health literacy and culturally varying beliefs about health which merit further exploration.

Presentations

• Armin, J. S., Williamson, H., Baldwin, J., & Etcitty, J. (2018, May). Improving Shared Decision Making Regarding Breast and Cervical Cancer Screening for Native American Women with Intellectual and/or Developmental Disabilities,. Annual Tribal Cancer Collaborative Meeting. Flagstaff, AZ: Arizona Department of Health Services.
• Redondo, F., Trejo, J., Armin, J. S., Hamann, H., Weihs, K. L., & Marshall, C. A. (2018, November). Partnering with a statewide professional organization of community health workers (CHWs) to support families managing cancer. American Public Health Association annual conference.
• Armin, J. S. (2016, April). Using ethnography to conduct cancer disparities research. Cancer Prevention and Control Seminar: University of Arizona Cancer Center.
• Armin, J. S., & Ali-Akbarian, L. (2016, November). Physicians’ Ethical Stances in Advance Care Planning. American Anthropological Association Annual Meeting. Minneapolis, MN.
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  Organized Session, Oral PresentationAdvance care planning (ACP) requires that individuals think hypothetically about how they would like to live their remaining life should illness or accident find them unable to make treatment decisions. In the case of cancer, a broad category of disease that refers to both manageable and life-limiting conditions, ACP conversations in the clinic may have immediate relevance due to advancing disease or they may invoke the specter of death at a time when patients are in remission or undergoing curative treatment. Further complicating the process of ACP in a cancer care clinic, the difference between curative and palliative care may be unclear to patients and the implications of patients’ specific illness trajectories may be unknown to both patients and physicians. ACP conversations inhabit a knowledge regime that Sharon Kaufman calls reflexive longevity, in which patients and their families determine within the clinical space how to live the time that is left in one’s life. Moreover, this reflexive process configures how physicians articulate ACP in relation to the specifics of medical management for a particular patient’s illness. This paper reports our reflections on a project in which we piloted a decision support tool along with an evidence-based advance care planning video in a cancer center’s supportive care clinic. Our preliminary findings point to the friction that emerges through processes of standardization and improvisation in the clinical context. In this paper, we begin to explore the ways in which physician approaches to ACP position them ethically in relation to patient care.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free. Technology Preview. 37th Annual Meeting of the Society of Behavioral Medicine. Washington DC.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free. Technology Preview. 37th annual meeting of the Society of Behavioral Medicine. Washington DC.
• Armin, J. S. (2015, March). Bringing the people into health policy: Managing cancer among structurally vulnerable women. Society for Applied Anthropology Annual Meeting. Pittsburgh, PA.
• Armin, J. S. (2015, November). "The Care and the Financial Part Go Hand-in-Hand": Health Care Professionals' Perspectives on the Care of Structurally Vulnerable Cancer Patients. Annual Meeting of the American Anthropological Association. Denver CO.

Poster Presentations

• Bueno, Y., VerHoeve, E., Armin, J. S., Ali-Akbarian, L., Calhoun, B., Hamann, H., Johnson, N., Hernandez, M., & Pape, M. (2019, May). Implementing a cancer navigation program to improve oncology and primary care coordination. El Rio Research Fair. Tucson AZ: El Rio Health.
• Farkas, J., Armin, J. S., Olivas, G. Z., Schweers, L., & Parent-Johnson, W. S. (2019, Nov). Integrating Best Practices of Cultural Diversity and Linguistic Accessibility into an Employment Training Program for Young People with Disabilities. Association of University Centers on Disability Annual Meeting. Washington DC.
• Olivas, G. Z., Armin, J. S., & Farkas, J. (2019, Nov). Enhancing Cultural and Linguistic Competence: Results of Sonoran UCEDD Demographic Data Collection Pilot. Association of University Centers on Disability. Washington DC.
• Algotar, A., Armin, J. S., & Aldama, J. (2018, March). Engaging key stakeholders to understand prostate cancer survivor preferences for and perceived barriers to a lifestyle modification intervention. American Society for Clinical Oncology Annual Meeting. NY, NY: American Society for Clinical Oncology.
• Armin, J. S., Williamson, H., Baldwin, J., & Lockwood, B. (2018, June). Building Partnerships with American Indian Communities to Increase Cancer Screening Among Women with Disabilities in Arizona.. Academy Health Annual Research Meeting – Disability Interest Group Meeting.
• Armin, J. S., Ali-Akbarian, L., Garland, L. L., & Muramoto, M. L. (2017, April). Improving advance care planning for cancer patients through better care coordination. UACC Scientific Retreat. Tucson, AZ: UACC.
• Sollars, J., Armin, J. S., Farkas, J., & Cohen, L. J. (2017, November). Advancing Person-Centered Planning in Long-Term Care: Lessons Learned from the Sonoran UCEDD’S Collaboration with Arizona’s Medicaid Program. Association of University Centers for Disability (AUCD. Washington DC.
• Armin, J. S., Ali-Akbarian, L., Debo, M., Hamann, H., Muramoto, M. L., & Calhoun, E. (2016, June). Implementing an Advance Care Planning Video Decision Aid in a Cancer Center’s Supportive Care Clinic. 8th Biennial Cancer Survivorship Research Conference: Innovation in a Rapidly Changing Landscape. Washington DC.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 2-4). See Me Smoke-Free: Development and feasibility of an mHealth app for women to address smoking, diet and physical activity. Annual meeting of the Society for Research on Nicotine and Tobacco. Chicago, IL.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free: Results of a feasibility trial of an mHealth app for women to address smoking, diet and physical activity.. 37th annual meeting and scientific sessions of the Society of Behavioral Medicine. Washington DC.
• Gordon, J. S., Gordon, J. S., Cunningham, J. K., Cunningham, J. K., Johnson, T., Johnson, T., Armin, J. S., Armin, J. S., Hingle, M. D., Hingle, M. D., Giacobbi, P., & Giacobbi, P. (2016, March 2-4). See Me Smoke-Free: Development and feasibility of an mHealth app for women to address smoking, diet and physical activity. Annual Meeting of the Society for Research on Nicotine and Tobacco. Chicago, IL.
• Gordon, J. S., Gordon, J. S., Gordon, J. S., Cunningham, J. K., Cunningham, J. K., Cunningham, J. K., Johnson, T., Johnson, T., Johnson, T., Armin, J. S., Armin, J. S., Armin, J. S., Hingle, M. D., Hingle, M. D., Hingle, M. D., Giacobbi, P., Giacobbi, P., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free: Results of a feasibility trial of an mHealth app for women to address smoking, diet and physical activity.. 37th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine. Washington DC.
• Ryan, A. M., Ryan, A. M., Pettit, J. M., Pettit, J. M., Armin, J. S., & Armin, J. S. (2016, April). Better Together: Using Medical-Legal Partnerships to Enhance Residency Advanced Care Planning Education. 2016 Medical-Legal Partnership Summit. Indianapolis, IN.

Reviews

• Armin, J. S. (2018. Book Review: Not Quite a Cancer Vaccine: Selling HPV and Cervical Cancer by S.D. Gottlieb.