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Rebkha Atnafou

Rebkha Atnafou-Boyer, MPH, Research Associate, Johns Hopkins School of Medicine, and CEO and Founder, RnD Associates Rebkha Atnafou-Boyer, MPH, is a Research Associate at Johns Hopkins School of Medicine conducting cancer prevention, screening, and support research. As Associate Director at Johns Hopkins Urban Health Institute (UHI), she is the director of the Bunting Neighborhood Leadership Program (BNLP), an intensive leadership fellowship and mentoring program for emerging community leaders in Baltimore City. Rebkha, is also the founder and CEO of RnD Associates Inc, a capacity building entity in Maryland providing training, technical assistance, mentoring, community asset and needs assessment, strategic planning, and program evaluation services. Beyond the BNLP fellows, she applies her passion for mentoring students as a faculty adviser to Africa Business Club at Johns Hopkins Carey Business School, and Zeni’s Gift, an initiative she initiated and named after her mother, to provide academic and professional development guidance to students and professionals primarily from Ethiopia and other African countries, and African Africans. Rebkha has diverse professional experience in leadership development, sexual health, systems design, adolescent health and development, building quality systems that promote health and community assessments. Her expertise is broad with specialties that encompass the promotion of health, gender equity, sexual health, illuminating sociocultural barriers to cancer prevention, youth development, and afterschool quality systems. She also brings strategic advisory capabilities, as an advisor engaged in high level talks with heads of state, senior government officials, and academic institutions. She serves on the board of Omarichet Space, Kenya

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Papers by Rebkha Atnafou

Health Behavior and Policy Review, 2021

Objective: Young adult tobacco users are at an increased risk for using non-cigarette tobacco pro... more Objective: Young adult tobacco users are at an increased risk for using non-cigarette tobacco products and have high poly-use rates. We interviewed poly-tobacco-using young adults from an urban community to explore characteristics associated with their poly-tobacco use, perceived barriers to tobacco cessation, and recommendations for and interest in cessation programs. Methods: We conducted 17 focus group discussions with 97 poly-tobacco-using young adults. Interviews were analyzed using framework analysis and quantitative surveys were analyzed using descriptive statistics. Results: All participants reported a history of tobacco product poly-use, and 85% reported poly-use in the past 30 days. Study results indicate that this population faces multiple barriers to cessation (eg, influence of social network, easy access, anxiety management, belief in self-control, boredom), but that there is interest in utilizing mobile-based interventions and social media for cessation attempts, ultim...

A number of JACH’s experiences during its first ten years of caring for orphans contributed to th... more A number of JACH’s experiences during its first ten years of caring for orphans contributed to the 1996 decision to deinstitutionalize. As the years passed and the children in JACH homes grew, JACH staff observed that the children had little knowledge about their society and the world at large due to their lack of exposure to community life. Many orphans felt alienated from their nonorphaned classmates. Some orphans exhibited aggressive behavior in school, partly because they were labeled as orphans and mocked by other students.

Introduction: Colorectal cancer (CRC) is the third leading cause of new cancer cases and the seco... more Introduction: Colorectal cancer (CRC) is the third leading cause of new cancer cases and the second leading cause of cancer mortality. Moreover, African-American women and men are more likely to die from colorectal cancer than their white counterparts. We report qualitative data from nine focus group discussions (FGD) conducted in centers serving a low-income, primarily African- American population in East Baltimore. Methods: Nine FDGs were conducted in health, drug treatment and social service centers across East Baltimore with a total of 127 individuals. A structured interview guide was developed with a focus on three key areas: 1) participants’ understanding and interpretations of health, 2) understandings and knowledge about cancer and colorectal cancer, and 3) promoters and barriers to colorectal cancer screening. Transcripts of interviews were coded and analysis was performed using grounded theory methodology and Nvivo software. Results: Key facilitators for seeking colonoscop...

American Journal of Gastroenterology, 2015

American Journal of Gastroenterology, 2016

Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the... more Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the second leading cause of cancer death in our country. Th e adenoma detection rate has been recommended as one of the main quality indicator. Th e adenoma detection rate (ADR) is 25%. ADR is 30 % for men and 20% for women. ADR is the quality indicator with the strongest association to post-colonoscopy colorectal cancer or missed colorectal cancer. Improved adenoma detection rate will decrease the incidence of post-colonoscopy colorectal cancer. Newer studies have shown that for each 1% increase in ADR, risk of "missed" CRC decreases by 3%. Th ere are very few studies regarding the adenoma detection rate in Colonoscopy performed in a small ambulatory surgery center. Methods: All patients who underwent screening colonoscopies in our ambulatory surgery center between 2013 to 2015 were included in the data analysis. Th e ADR is defi ned as the number of patients out of every 100 undergoing fi rst time screening colonoscopy who have at least one adenoma removed. Th e withdrawl time was more than 6 minutes in all the screening colonoscopies. Th e cecal intubation rate was 96.8% in our center. Most of the patient's used split dose colonic prep. Th e patient's with incomplete colonoscopy secondary to poor prep was excluded from the analysis. Results: Th ere were 4486 procedures performed by two physicians in our ambulatory surgery center. 54.3 % were colonoscopies, 28.8% were upper endoscopies, 0.2 were fl exible sigmoidoscopies. 16.6 % were minor surgical procedures like skin abscess drainage, port placement. 616 patient's underwent screening colonoscopies. Th e mean age of screening colonoscopy group was 58.6 years. Our youngest patient was 50 years old and the oldest was 79 years old. 58.2 % were females and 41.8% were males. 291 patients were found to have adenoma giving adenoma detection rate of 47%. Conclusion: High adenoma detection rate can be achieved in small community ambulatory surgery center provided high quality measures like high cecal intubation rate, good quality prep, increased withdrawl time are achieved diligently. Newer technologies like Fusion scope by Endochoice will also increase the adenoma detection rate. ADR as a quality measure are now being tracked by Medicare and commercial insurance companies. Added pay for performance ADR benchmarks being considered and granted by some commercial payers.

Health Behavior and Policy Review, 2019

Objective: We examined reasons for e-cigarette use, tobacco product polyuse, and tobacco cessatio... more Objective: We examined reasons for e-cigarette use, tobacco product polyuse, and tobacco cessation interest among tobacco-using young adults from an urban setting. Methods: Participants (N = 97) completed a risk factor survey. Descriptive statistics and prevalence estimates of polytobacco use patterns, motivations for tobacco use, tobacco cessation interest, and beliefs and risk perceptions about tobacco use were explored. Results: All participants had a history of polyuse, and 85% were current polyusers. Stress was the primary reason reported for tobacco use. Compared to single-product users, current polyusers also were more likely to mention environment and cheap cost as reasons for use. Most participants perceived cigarettes to be as addictive as cocaine or heroin, although this perception was less common among e-cigarette users than non-users. Among study participants, 59% reported wanting to stop using tobacco completely. Among current polyusers, those that used e-cigarettes we...

Health Communication, 2018

Family cancer history (FCH) can shape prevention and early detection behaviors to decrease cancer... more Family cancer history (FCH) can shape prevention and early detection behaviors to decrease cancer risk. However, many individuals are unaware of increased risk for cancers based on family patterns. For some African-American communities, communication about FCH is rare and barriers have not been well studied. To optimize the use of FCH, it is crucial to understand how patients gather and share FCH with relatives and healthcare providers. We conducted four focus groups (n = 40) and seven key informant interviews (n = 9) to investigate knowledge, experiences, and barriers/promoters of FCH in the East Baltimore African-American community. Thematic analysis identified 14 distinct themes across six communication domains: participants' understanding of FCH, past FCH communication with family and providers, barriers to FCH communication, promoters of FCH communication, suggestions for future communication, and community health priorities. FCH was most often defined by narratives of family cancer experiences, and the majority of participants had shared little FCH with family members. Five psychosocial domains were commonly reported as barriers to sharing FCH: fear/denial, pride/dignity, selflessness/selfsacrifice, cancer fatalism, and distrust/skepticism of medical care. Diagnosis/death and caregiving/ social support promoted FCH communication and encouraged cancer prevention behaviors such as screening. Although most participants had experienced cancer in their families, communication about FCH was low and psychosocial barriers were common. Understanding these communication domains in minority populations is crucial to developing interventions to address disparities in cancer prevention and control, particularly where effective screening and care recommendations exist for those with positive family histories. Cancer is the second leading cause of death in the United States. However, the burden of cancer is not equally distributed; African-Americans remain more likely to die from cancer than any other racial or ethnic group in the United States. Cancer death rates for non-Hispanic black men and women are 29% higher and 15% higher, respectively, compared to their non-Hispanic white counterparts (American Cancer Society, 2018). Each year around

Health Behavior and Policy Review, 2018

Objective: In this study, we sought to understand why young adults from urban low-income regions ... more Objective: In this study, we sought to understand why young adults from urban low-income regions discontinue using e-cigarettes. Methods: We recruited 97 tobacco users aged 18-26 years from Baltimore, Maryland to participate in 17 focus groups. Qualitative data were analyzed using framework analysis. Results: Being less satisfying than combustible tobacco, perceived cumulating costs, and negative physical effects were expressed as top reasons for never using or discontinuing the use of e-cigarettes. Conclusion: Understanding why young adults discontinue e-cigarette use is critical to inform ecigarette intervention efforts and public policy. If e-cigarettes are to be promoted as harm reduction devices for combustible tobacco users, it will be important to ensure that they are affordable, satisfying, and formulated to minimize negative physical effects.

Journal of Adolescent Health, 2017

Journal of Safety Research, 2003

Problem: Intentional and unintentional injury prevention efforts have traditionally been independ... more Problem: Intentional and unintentional injury prevention efforts have traditionally been independent and non-integrated. Fostering collaboration between the sub-fields would enhance work within both sub-fields and advance injury prevention work as a whole. Method: A systematic assessment of similarities and differences between the sub-fields was performed, including an examination of relevant definitions and norms, research methods and findings, key risk and resiliency factors, and prevention strategies that would promote collaboration and better advance current prevention efforts. Results/Summary: Several areas exist in which injury prevention efforts could be coordinated or ideas and practices could be cross-applied, including training of practitioners, data collection and analysis, application of tools and methodologies, examination of risk and resiliency factors, and identification of funding sources and partners. Impact on Industry: This paper delineates how intentional and unintentional injury prevention practitioners can more effectively collaborate to promote safer environments and further reduce incidence of injury. An integrated injury prevention approach could significantly impact the underlying contributors to both types of injury, allowing practitioners within both sub-fields to achieve greater outcomes through increased credibility, reduced duplication of efforts, more efficient use of resources, and unified injury prevention messages.

Journal of Adolescent Health, 1999

American Journal of Public Health, 1999

OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in ... more OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with cl...

Cancer Epidemiology, Biomarkers & Prevention, 2020

Background/Purpose: Polyuse of tobacco products is increasing among urban young adults. Understan... more Background/Purpose: Polyuse of tobacco products is increasing among urban young adults. Understanding different use profiles and the obstacles that this population faces in an attempt to quit smoking is important to inform effective cessation programs. We explored perceived barriers to tobacco cessation and recommendations for/interest in cessation programs among urban young adult polytobacco users. Methods/Approach: 17 focus groups were conducted among 97 tobacco users between the ages of 18 and 26 from Baltimore, Maryland. Qualitative data were analyzed using framework analysis. Results/Findings: All participants reported a history of tobacco product polyuse, and 85% reported polyuse in the past 30 days. Several barriers to tobacco cessation emerged, including: influence of social network, easy access, source of stress relief (anxiety management), belief in self-control (ability to stop on own if desired), and boredom. Most participants reported little interest in or success with ...