Julie S Armin
- Assistant Professor, Family and Community Medicine
- Assistant Professor of Practice, Health Promotion Sciences
- Member of the Graduate Faculty
Julie is a medical anthropologist who focuses on access to health care--from screening to survivorship--for people living with cancer.
- Ph.D. Anthropology
- University of Arizona, Tucson, AZ, Arizona, United States
- Organizing care: U.S. health policy, social inequality, and the work of cancer treatment
Access to cancer care for socially and economically marginalized patients.
Health disparities; Structural competence in health care; social inequity and health effects
Disability Directed Res ExpFCM 492A (Spring 2023)
Honors ThesisPSIO 498H (Spring 2023)
Independent StudyFCM 899 (Spring 2023)
Disability Directed Res ExpFCM 492A (Fall 2022)
Histories of Health InequityFCM 896H (Fall 2022)
Honors ThesisPSIO 498H (Fall 2022)
Independent StudyFCM 599 (Spring 2022)
Directed ResearchPSIO 492 (Spring 2021)
Histories of Health InequityFCM 896H (Spring 2021)
Independent StudyFCM 399 (Spring 2021)
Histories of Health InequityFCM 896H (Fall 2020)
Disability Directed Res ExpFCM 492A (Spring 2020)
Honors ThesisHNRS 498H (Spring 2020)
Independent StudyFCM 899 (Spring 2020)
Bodies in MedicineANTH 325 (Fall 2019)
Independent StudyFCM 399 (Spring 2019)
Disability PerspectivesFCM 496D (Fall 2018)
Independent StudyFCM 399 (Fall 2018)
Disability PerspectivesFCM 496D (Spring 2018)
Disability PerspectivesFCM 596D (Spring 2018)
Directed ResearchNSCS 492 (Fall 2017)
Independent StudyFCM 599 (Spring 2017)
- 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.
- 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.
- Armin, J. S., Williamson, H. J., Begay, A., Etcitty, J., Attakai, A., Russell, K., Baldwin, J. A., Armin, J. S., Williamson, H. J., Begay, A., Etcitty, J., Attakai, A., Russell, K., & Baldwin, J. A. (2022). Adapting a Cancer Screening Education Program for Native American Women with Disabilities. International journal of environmental research and public health, 19(15).More infoLike other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, "What are the influences on breast and cervical cancer screening for Native American women with IDD?" with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD.
- Armin, J. S., Marshall, C. A., & Kroeger, S. (2021). Exploring the Experiences of University Students with a History of Cancer: A Pilot Study.. Journal of Cancer Education, 36(2), 294-298. doi:10.1007/s13187-019-01627-xMore infoThis exploratory pilot study aims to provide preliminary data describing the experiences of university student cancer survivors, quantify their connection to the campus Disability Resource Center, and assess the feasibility of conducting research with this population. In this descriptive study of cancer survivor students at one large university in the southwestern U.S., online survey respondents with a history of cancer (N = 19) reported cognitive, emotional, and physical limitations that affected their educational experience. The majority (78.9%) of our participants were children, adolescents, or young adults (up to age 39) when diagnosed with cancer; all others were diagnosed between 40 and 60 years old. We found that students living with cancer have short- and long-term impairments, including memory issues that made academic performance difficult. These effects led some students to cope individually while others sought support from institutional entities or instructors. Here we document survivor experiences and propose next steps in research, which includes an intervention that builds on our preliminary findings and uses the positive deviance model.
- Gordon, J. S., Nair, U. S., Gordon, J. S., Giacobbi, P. R., Bell, M. L., & Armin, J. S. (2021). A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial.. Translational behavioral medicine, 11(2), 516-529. doi:10.1093/tbm/ibaa052More infoEvidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach..To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model..Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction..Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence..The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted..NCT02968381.
- Gordon, J. S., Sbarra, D., Armin, J., Pace, T. W., Gniady, C., & Barraza, Y. (2021). Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19-Related Stress: Pilot Feasibility Study. JMIR formative research, 5(10), e32353.More infoThe SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure.
- Lee, M. S., Peart, J. R., Armin, J. S., & Williamson, H. J. (2021). A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. Journal of Health Disparities Research and Practice. doi:https://digitalscholarship.unlv.edu/jhdrp/vol14/iss3/2
- Lee, M., Peart, J., Armin, J. S., & Williamson, H. (2020). A Systematic Review of Facilitators and Barriers to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. Journal of Health Disparities Research and Practice.
- Lefkowitz, D., & Armin, J. S. (2021). Why Employment During and After COVID-19 Is a Critical Women's Health Issue.. Women's health issues : official publication of the Jacobs Institute of Women's Health, 31(3), 190-194. doi:10.1016/j.whi.2020.12.004
- Marshall, C. A., Curran, M. A., Trejo, J., Gonzalez, A. A., Armin, J., Hamann, H. A., Badger, T. A., & Garcia, F. A. (2021). The Evolution of Un Abrazo Para La Familia: Implications for Survivors of Cancer. Journal of cancer education : the official journal of the American Association for Cancer Education, 36(5), 1075-1080.More infoUn Abrazo Para La Familia™ (Abrazo) is a 3-h modular preventive intervention designed for low-income caregivers who are co-survivors of cancer. Here we (1) consider the benefit to survivors of cancer, that is, the care recipients who participate in Abrazo; (2) summarize the literature specific to research outreach to low-income, underserved populations when they are faced with cancer; and (3) describe current steps being taken in Southern Arizona to reach these populations via Abrazo. Specific to considering the benefit to care recipients, we analyzed care recipient data derived from three existing cohorts of Abrazo participants. Analyses of the combined cohorts of these data demonstrate that Abrazo is effective with care recipients given statistically significant higher cancer knowledge and self-efficacy scores, pre- vs. post-intervention. We can now report benefit to care recipients who participate in Abrazo. This allows us, with confidence, to expand research recruitment efforts to include care recipients as part of the Abrazo intervention in our efforts to serve low-income, underserved populations when faced with cancer.
- Marshall, C. A., Trejo, M. J., Trejo, J. I., Armin, J. S., Badger, T. A., & Weihs, K. L. (2021). Implementation of Un Abrazo Para La FamiliaTM in southern Arizona with extension to survivors and assessment of effects on distress. Families, systems & health : the journal of collaborative family healthcare, 39(2), 269-281.More info[Embracing the Family] (Abrazo) is a 3-hr psychoeducational intervention designed for low-income informal caregivers who are cosurvivors of cancer. A rehabilitation-informed preventive intervention, Abrazo reflects the importance of family, culture, and socioeconomic background. A pilot study was conducted to inform a larger geographic implementation of Abrazo. The aims were to determine if previous outcomes of increased cancer knowledge and self-efficacy could be replicated and to investigate intervention effects on distress. A pretest-posttest design was used to assess changes in cancer knowledge, self-efficacy, and distress for Abrazo participants. Distress was measured with the American Medical Association's Caregiver Assessment (Epstein-Lubow et al., 2010) and the National Comprehensive Cancer Network Distress Thermometer (Donovan et al., 2014; Forsythe et al., 2013; Fulcher & Gosselin-Acomb, 2007). The Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009) measured symptoms of anxiety and depression. Both survivors ( = 37) and cosurvivors ( = 103) increased in cancer knowledge and self-efficacy after completing Abrazo. Mean levels of distress and symptoms decreased for cosurvivors, but not for survivors. At study entry, 19% of cosurvivors and 12% of survivors scored ≥6/12 on the PHQ-4, the standard cutoff for clinically significant symptoms. Only 13% of cosurvivors, but 30% of survivors exceeded this threshold at three-month follow-up. Elevated symptoms persisted in 12% of survivors from baseline to follow-up; in 18% of survivors, symptoms rose between baseline and follow-up. Increased cancer knowledge and self-efficacy in participants replicates evidence of Abrazo's effectiveness. The result of decreased distress in cosurvivors extends our understanding of Abrazo's effectiveness with this population. The increase in distress in cancer survivors warrants further attention to their intervention needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
- Samtani, G., Bassford, T. L., Williamson, H., & Armin, J. S. (2019). Cancer treatment and survivorship outcomes for people with developmental disabilities, a review of the literature. Intellectual and Developmental Disabilities.
- Williamson, H. J., Armin, J. S., Stakely, E., Nasimi, B., Joseph, D. H., Meyers, J., & Baldwin, J. A. (2021). Community-Engaged Research to Address Health Disparities of Indigenous Women With Disabilities. Annals of international occupational therapy, 4(3), e158-e165.More infoTo address health disparities among underserved populations, occupational therapists can participate in community-engaged research and practice to improve access to preventive health services.
- Williamson, H. J., Samtani, G., Bassford, T. L., & Armin, J. S. (2021). Are Researchers Addressing Cancer Treatment and Survivorship Among People With Intellectual and Developmental Disabilities in the U.S.? A Scoping Review.. Intellectual and developmental disabilities, 59(2), 141-154. doi:10.1352/1934-9556-59.2.141More infoPeople with intellectual and developmental disabilities (PWIDD) often encounter barriers in the health care system when seeking general and specialized medical care. Literature has shown that PWIDD experience a lack of proper screening for and prevention of cancer compared to the general population. However, less is known regarding the cancer care and survivorship of PWIDD, especially in the United States. In this review, we examine what is currently known about the primary, psychosocial, and palliative care of PWIDD diagnosed with cancer. Our analyses reveal an immediate need for improvement in caregiver support, collaboration among health care providers, and ethical approaches to information disclosure for this population, as well as the establishment of more reliable standards of care through additional research with PWIDD.
- Armin, J. S., Nair, U. S., Giacobbi, P. R., Povis, G., Barazza, Y., & Gordon, J. S. (2020). Developing a Guided Imagery Telephone-Based Tobacco Cessation Program for a Randomized Controlled Trial.. Tobacco Use Insights. doi:http://hdl.handle.net/10150/634535
- Jarillo, T. C., Rothers, J., Armin, J. S., Williamson, H. J., Baldwin, J., Adams, M., Becenti, M., Begay, A., Etcitty, J., Lee, M., Lelli, L., Lockwood, B., Núñez, C., Sasse, S., & Rodriguez, N. (2020). Abstract PO-026: Refining a breast and cervical cancer screening program for Native American women with disabilities. Cancer Epidemiology, Biomarkers & Prevention, 29(12_Supplement), PO-026-PO-026. doi:10.1158/1538-7755.disp20-po-026
- Lefkowitz, D., & Armin, J. S. (2020). Why Employment During and After COVID-19 Is a Critical Women's Health Issue. Women's health issues : official publication of the Jacobs Institute of Women's Health.
- Nair, U., Armin, J. S., Giacobbi, P., Povis, G., Barraza, Y., & Gordon, J. S. (2020). Developing a Guided Imagery Telephone-Based Tobacco Cessation Program for a Randomized Controlled Trial. Tobacco Use Insights, 13, 1179173X2094926. doi:10.1177/1179173x20949267
- Williamson, H. J., Sasse, S., Rothers, J., Rodriguez, N., Nunez, C., Lockwood, B., Lelli, L., Lee, M., Jarillo, T. C., Etcitty, J., Begay, A., Becenti, M., Baldwin, J. A., Armin, J., & Adams, M. (2020). Abstract PO-026: Refining a breast and cervical cancer screening program for Native American women with disabilities. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1538-7755.disp20-po-026
- Armin, J. (2019). Administrative (in)Visibility of Patient Structural Vulnerability and the Hierarchy of Moral Distress among Health Care Staff. Medical anthropology quarterly.More infoPublic 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. (2019). Not Quite a Cancer Vaccine: Selling HPV and Cervical Cancer. S. D. Gottlieb, New Brunswick, NJ: Rutgers University Press, 2018, 200 pp.. Medical Anthropology Quarterly, 33(2). doi:10.1111/maq.12472
- 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.
- Chico-jarillo, T. M., Williamson, H. J., Rothers, J., Nasimi, B., Lockwood, B., Etcitty, J., Chico-jarillo, T. M., Cherup, E., Baldwin, J. A., & Armin, J. (2019). Abstract 2431: Working with stakeholders to adapt a cancer screening education program for Native American women with intellectual disabilities. Cancer Research. doi:10.1158/1538-7445.sabcs18-2431
- 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.More infoOur 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., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S. M., Jacobs, T. A., Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S. M., Jacobs, T. A., Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S. M., & 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
- 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.
- 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.More infoThis 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.More infoInternet 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.More infoThis study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease.
- Armin, J. (2013). Book Review: Arizona, A History. Thomas E. Sheridan.. Arizona Anthropologist, 23, 33-36.
- 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.More infoMany 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., Orzech, K. M., Vivian, J., & Huebner Torres, C. (2012). Diet and Exercise Adherence and Practices Among Medically Underserved Patients With Chronic Disease. Health Education & Behavior, 40(1), 56-66. doi:10.1177/1090198112436970
- 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.More infoResearch 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.More infoWhile 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.More infoCancer 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.More infoDiverse 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.
- Armin, J., Vivian, J., Vargas, A., Shaw, S. J., Reyes, V., Orzech, K. M., Nguyen, L., Markham, J., Leverance, C., Huebner, C., Awad, A., & Armin, J. (2009). Abstract B85: Consistency attitudes towards cancer screenings in four ethnic groups. Cancer Epidemiology and Prevention Biomarkers, 18.More infoBackground: While previous research suggests that patients who have one cancer screening may be positively inclined to have additional screenings, cultural and ethnic differences in attitudes towards screenings are less well explored. Drawing on both qualitative and quantitative data, we will outline variation in cancer screening utilization and attitudes across four ethnic groups in a primary care setting. Methods: In our multimethod, prospective study, “The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes,” we explore factors associated with attitudes towards cancer screening among patients at a Section 330 community health center. Standard knowledge, belief and attitude (KBA) and utilization scales were completed by 350 patients from 4 ethnic groups (Latino, Vietnamese, African-American, white) as part of larger epidemiological surveys conducted with patients diagnosed with diabetes and/or hypertension. Surveys are orally administered in the language of the patient9s choice by bilingual, bicultural interviewers. Quantitative data are analyzed using SPSS and qualitative data using Atlas.ti. Results: Participants9 attitudes towards cancer screening tend to generalize across screening types. High levels of internal consistency were found across items examining attitudes towards several types of cancer screening tests (for men, PSA, DRE, FOBT, colonoscopy; for women, mammogram, BSE, FOBT, colonoscopy). Attitudinal consistency was particularly marked for men, for African-American, and for Latino participants, especially when individual items were combined into scales reflecting overall positive or negative beliefs about cancer screening (e.g., a given screening will be painful, expensive, or take too much time). In addition, we find consistent differences in attitudes among the four ethnic groups. Latinos have the most negative beliefs about cancer screenings, while Vietnamese participants have the most positive attitudes. Among all ethnic groups, negative attitudes towards cancer screenings appear closely related to utilization. For example, with few exceptions, those who have not had a given test hold more negative attitudes towards the test in question. Discussion: These results suggest that a favorable attitude towards one form of cancer screening might favorably dispose a patient toward all forms, and that utilization of any cancer screening test may positively influence a patient9s attitudes towards other types of screenings. Conclusions: Given that Latinos underutilize many types of cancer screenings, it perhaps not surprising that they also hold the most negative attitudes in our study if screening utilization positively influences attitudes towards screenings. Expanding access to cancer screenings by addressing barriers to care including language and insurance coverage may be important interventions to address Latinos9 and other groups9 attitudes towards cancer screenings. We present recommendations for primary health care providers for improving communication with ethnically diverse patients with limited health literacy around cancer screening utilization.
- 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.More infoCultural 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.
- Corral, J., Dickerson, F., Rodriguez, N., Murrain, V. E., Cagno, C. K., Ortiz, M., Armin, J. S., Parikh, T. M., & Goel, S. (2021, April). Creating Antiracist MD Program by Transforming Assessments, Faculty Development, Scholarships. AAMC GSA-OSR. Virtual: AAMC.
- Allen, A. M., Armin, J. S., Bueno, Y., Mallahan, S., & Macpherson, A. J. (2020, December). Nonpharmacological Interventions for Postpartum Opioid Use Disorder. Polysubstance Abuse in Pregnancy and Newborns. Remote: Polysubstance Abuse in Pregnancy and Newborns.
- Cagno, C. K., Armin, J. S., & Murrain, V. E. (2020, July / Summer). Mitigating Unconscious Bias in Health Care. Presentation for American College of Osteopathic Physicians (ACOFP) National Live Webinar. Virtual - live: ACOFP.
- Armin, J. S., Bedwell, R., Ali-Akbarian, L., Garland, L. L., & Muramoto, M. L. (2018, April). Discussing what to do if “things don’t go the way we want them to”: Insights from oncologists about advance care planning. Society for Applied Anthropology/Society for Medical Anthropology. Philadelphia, PA.
- 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.More infoOrganized 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.
- Kolman, K. B., Elliott, T., Meehan, E., Armin, J. S., Aldulaimi, S., Allen, A. M., & Pettit, J. M. (2020, May). Roadmap to research: Improving the resident research experience with an innovative scholarly project curriculum. Society for Teachers of Family Medicine.
- Armin, J. S., Williamson, H., Rothers, J. L., Baldwin, J., Adams, M., Becenti, M., Begay, A., Chico-Jarillo, T., Lee, M., Etcitty, J., Lelli, L., Lockwood, B., Nunez, C., Sasse, S., & Rodriguez, N. (2020, October). Refining a breast and cervical cancer screening program for Native American women with disabilities. American Association for Cancer Research, The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. virtual.
- Gordon, J. S., Armin, J. S., Bell, M. L., Giacobbi, P., Nair, U. S., & Barazza, Y. (2020, March). A guided imagery smoking cessation intervention delivered using a telephone quitline model: Results of a randomized feasibility trial. Society for Research in Nicotine and Tobacco. New Orleans.
- Gordon, J. S., Armin, J. S., Bell, M. L., Nair, U. S., Giacobbi, P., & Barrazza, Y. (2020, Spring 2020). A guided imagery smoking cessation intervention delivered using a telephone quitline model: Results of a randomized feasibility trial.. Annual Conference for the Research in Nicotine and Tobacco. New Orleans, LA.: Society for Research in Nicotine and Tobacco.
- Mallahan, S., Walden, C., Armin, J. S., Bueno, Y. M., Allen, A. M., & Macpherson, A. J. (2020, March). Development of an Adjunctive Behavioral Treatment for Opioid Use Disorder during the Postpartum Period. Public Health Poster Forum. University of Arizona - virtual: Mel and Enid Zuckerman College of Public Health.
- 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., 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., 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.
- 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.
- Armin, J. S. (2018. Book Review: Not Quite a Cancer Vaccine: Selling HPV and Cervical Cancer by S.D. Gottlieb.