Suzanne G Leveille

• PhD
• Professor Emeritus at University of Massachusetts Boston

Background While TB-related mortality in the US declined four-fold from 1990 to 2019, country-level estimates of TB burden obscure within-state racial heterogeneity and changes in TB burden over time. In sixteen US Southern States and Washington DC, the effects of health inequities engendered by Jim-Crow laws enacted from the late 1800s to the 1960...

Background Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, floss...

This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities....

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to c...

Objectives: To understand behaviors and attitudes of adults with diabetes who read their clinicians' visit notes. Methods: By linking a large 2017 patient survey involving three institutions with administrative and portal use data, we identified patients with diabetes mellitus from outpatient records and examined reading behaviors related to eli...

Background: Multisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. Aims: To recruit 100 racially diverse older adults with mul...

Background Diabetes and periodontitis are two intertwined chronic diseases linked by the inflammatory mechanism. Experimental studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is not clear whether good oral self-care behaviors such as flossing may reduce risk for periodontitis and improve glyce...

Background: Disability-adjusted life years (DALYs) are used to evaluate the relative burden of diseases in populations to help set prevention or treatment priorities. The impact of parental cardiovascular health (CVH) on healthy life years lost from cardiovascular disease (CVD) in adult offspring is unknown. We compared parent-offspring CVD DALYs...

Background Half of US adults aged 20–64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on...

Objectives This study aims to determine domains of pain interference in daily routines assessed using the Brief Pain Inventory, in relation to multisite musculoskeletal pain among older adults living in the community. Design The MOBILIZE Boston Study is a population-based study of 749 adults aged 70 and older. Measurements Chronic musculoskeletal...

Falls are a complex problem and play a leading role in the development of disabilities in the older population. While fall detection systems are important, it is also essential to work on fall preventive strategies, which will have the most significant impact in reducing disability in the elderly. In this work, we explore a prospective cohort study...

Background: Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. Objective: To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and s...

Background Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults.AimsTo examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults.Methods The MOBILI...

Background The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for...

BACKGROUND Self-management of health is becoming increasingly more influenced by Health IT as online patient portals become more common. Patient portals allow patients direct access to their health information and opportunities to engage with their healthcare team. Data suggest that e-Health literacy is an important skill for using portals. Emergin...

Background: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous stud...

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional...

Background Care partners are key members of patients’ health care teams, yet little is known about their experiences accessing patient information via electronic portals. Objective To better understand the characteristics and perceptions of care partners who read patients’ electronic visit notes. Patient involvement Focus groups with diverse pati...

Introduction: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. Methods: We performed a secondary analysis of data from t...

BACKGROUND Patients are uniquely positioned to document both their subjective experiences and goals for a medical encounter. OBJECTIVE To assess the effects of 12-month pilot interventions of co-generated visit notes. METHODS Patients at 6 primary care practices in 4 academic health centers were asked to provide unstructured interval histories an...

Background Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. Objective This study aims to assess patient and provider experiences and attitudes af...

Background Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring. Methods and results The study consisted of a total of 5967 offspring–mother–father trios derived from the Framingham Heart S...

Objectives Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention. Design Prospective longitudinal cohort study. Setting and Participants 417 community-dwelling adults age...

Objectives To develop and evaluate the validity of a scale to assess patients’ perceived benefits and risks of reading ambulatory visit notes online (open notes). Design Four studies were used to evaluate the construct validity of a benefits and risks scale. Study 1 refined the items; study 2 evaluated underlying factor structure and identified th...

Background Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults. Methods The MOBILIZE Boston Study enrolled 765 com...

Objectives: The study aim was to evaluate the associations among the presence of wisdom teeth (third molars, M3), periodontal disease, and serum C-reactive protein (CRP) in the US adult population, thus to generate population-based evidence to inform heart disease prevention and dental care. Study design: We performed secondary data analysis of...

Background Pain catastrophizing has been associated with pain intensity and mobility limitations in adults, and may be associated with mobility problems among older adults with chronic pain. This study examined the associations between pain catastrophizing and pain characteristics, and physical performance in older people. Methods The MOBILIZE Bos...

Background Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians.Objective We examined patients’ views on the clarity, acc...

Background: Poor oral care can contribute to periodontal disease (PD), which affects about half of U.S. adults. People with diabetes are more vulnerable to gum problems, thus practicing optimal oral care such as flossing is an important self-care behavior for this population. Objectives: To examine whether diabetes is associated with PD, poor oral...

Background: For five years in a row, sexually transmitted infections (STIs) have been rising steeply in the United States of America (US). Compared to the rates in 2014, chlamydia, gonorrhea, and syphilis (primary and secondary) have increased by 19%, 63%, and 71%, respectively. College-aged young adults (18-24 years) account for the highest rate o...

Importance As health information transparency increases, patients more often seek their health data. More than 44 million patients in the US can now readily access their ambulatory visit notes online, and the practice is increasing abroad. Few studies have assessed documentation errors that patients identify in their notes and how these may inform...

Background Evidence suggests familial aggregation and intergenerational associations for individual cardiovascular health ( CVH ) metrics. Over a 53‐year life course, we examined trends and association of CVH between parents and their offspring at similar mean ages. Methods and Results We conducted a series of cross‐sectional analyses of the FHS (...

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionn...

Objective To determine if poorer gait variability and gait coordination among mobility limited older adults is related to their slower walking speed. Design Cross-sectional analysis. . Setting University research laboratory Participants Community-dwelling adults aged > 68 years with (Short Physical Performance Battery score < 9; n=37) and withou...

Independent control of the right and left ankles (differentiation) may be a motor control mechanism linking impaired coordination and mobility limitations. We tested the hypotheses that motor control differentiation of the ankles, as measured using Cross-Sample Entropy, during antiphase coordination at two movement frequencies, is associated with i...

[This corrects the article DOI: 10.2196/13876.].

Evidence suggests that the practice of sharing clinicians’ notes with patients via online patient portals may increase patient engagement and improve patient–clinician relationships while requiring little change in providers’ workflow. Authors examined clinical social workers’ experiences and attitudes related to open psychotherapy notes using focu...

Importance The 21st Century Cures Act of 2016 requires that patients be given electronic access to all the information in their electronic medical records. The regulations for implementation of this law give patients far easier access to information about their care, including the notes their clinicians write. Objective To assess clinicians’ views...

Background: Clarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings. Objective: To investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling p...

Objective: We aimed to assess the impact of the burden and patterns of multi-morbidity on disability domains.In a cross-sectional study of 425 older adults from the Boston Rehabilitative Impairment Study of the Elderly, participants self-reported 13 chronic conditions and underwent assessment of body function (leg strength, velocity, and power, tr...

Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectiona...

This study examined the feasibility and acceptability of an exergaming program that utilized custom exergames, and compared it to a traditional physical exercise (control) program in older adults at risk for falls. A quasi-experimental study was conducted in older adults who lived in senior living communities. Participants enrolled in either progra...

Fall injuries are a leading cause of death among older adults, and chronic pain has been identified as a fall risk factor. However, the potential impact of chronic pain on injurious falls is unknown. This prospective study examined the relation between chronic pain and injurious falls in a 4-year follow-up of community-dwelling older adults. The MO...

Background: Poor oral care can contribute to periodontal disease (PD), which affects about half of U.S. adults. People with diabetes are more vulnerable to gum problems, thus practicing optimal oral care such as flossing is an important self-care behavior for this population. Objectives: To examine whether diabetes is associated with PD, poor oral...

Background: Poor oral care can contribute to periodontal disease (PD), which affects about half of U.S. adults. People with diabetes are more vulnerable to gum problems, thus practicing optimal oral care such as flossing is an important self-care behavior for this population. Objectives: To examine whether diabetes is associated with PD, poor oral...

Objective: To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults. Design: A cross-sectional study of a population-based cohort of older adults SETTING: Urban and suburban communities in a large metropolitan area PARTICIPANTS: Community-living...

Purpose: To test whether an 8-wk exergaming (EG) program would improve cognition and gait characteristics compared with a traditional physical exercise (TPE) program in older adults at risk for falling. Methods: A pilot quasi-experimental study was conducted in adults age ≥65 yr at risk for falls, living in senior communities. Participants enrol...

The purpose of this exploratory study was to examine the effects of Tai Chi on blood levels of beta endorphin (β-endorphin) and inflammatory markers in older adults with chronic pain. Forty community-dwelling older adults with chronic pain were randomized to Tai Chi or light physical exercise, and each offered twice weekly for 12 weeks. Following t...

Background Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites. Aims To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geria...

Background: Though patients’ access to clinicians’ visit notes may improve patient engagement and strengthen patient–clinician relationships, it is unknown whether these benefits extend to mental health settings. Aims: Examine patients’ attitudes and experiences reading their psychotherapists’ notes online. Methods: Using a mixed methods design, we...

BACKGROUND Following a 2010-2011 pilot intervention that offered primary care patients secure online portal access to their doctors’ office visit notes, these systems expanded “OpenNotes” to nearly all clinicians in primary care, medical and surgical specialty practices. OBJECTIVE To examine the ongoing experiences and perceptions of patients who...

Background: Following a 2010-2011 pilot intervention in which a limited sample of primary care doctors offered their patients secure Web-based portal access to their office visit notes, the participating sites expanded OpenNotes to nearly all clinicians in primary care, medical, and surgical specialty practices. Objective: The aim of this study...

Background Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low‐risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. Methods A retrospective secondary data analysis using birth registry data f...

Background Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention. Methods 365 primary care patients (age=77±7...

Objectives: To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations. Design: Cross sectional analysis using baseline data from an observational cohort study. Setting: Primary care. Participants: Community-dwelling olde...

Background Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults. AimsTo investigate the feasibility of a randomized controlled trial of mind-body exercise (Tai Chi) versus a light physical exercise in older adults with multisite pain. Methods Adults aged ≥ 65 years with multisite pain who reported falling in...

Although total knee replacement (TKR) surgery has become a common treatment for knee osteoarthritis, little is known about the overall impact of TKR on pain and mobility in the older population. This cross-sectional study examined chronic pain and mobility among community living adults aged ≥70y with and without TKR. The MOBILIZE Boston Study enrol...

Chronic musculoskeletal pain is linked to increased fall risk among elders. Older adults with chronic pain also experience mobility limitations. This prospective study examined the mediating effect of gait measures in the relationship whereby pain leads to falls. In the MOBILIZE Boston Study II of adults aged ≥70y living in the Boston area, 294 com...

Prevention of falls is a public health priority around the world. A key component in preventing falls is identification of factors that increase the risk of falls. Pain is a highly prevalent risk factor for falls and the role of cognition offers new avenues for investigation. Our symposium provides an epidemiologic perspective on the characteristic...

Accumulating evidence points to an increased fall risk among older adults who have persistent multisite pain. A better understanding of this pain hazard could lead to new interventions to reduce fall risk in older adults. The MOBILIZE Boston Study II included a battery of tests to assess the attentional domain, as well as the problem of persistent...

Chronic musculoskeletal pain (CMP) contributes to increased fall risk among older adults. Fall often occurs due to loss of standing balance. Standing postural control is “complex”, depending upon numerous inputs interacting across multiple temporal-spatial scales. The decreased complexity has been linked to increased fall risk. Pain may interfere w...

One in five elders in the U.S. are edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g. diabetes) have been identified as possible risk factors for edentulism, data on multiple chronic conditions in relation to tooth loss is lacking. This study examined the association...

The relation between pain quality and fall risk is understudied. Understanding the role of pain quality in fall risk could inform tailored fall prevention interventions. A population-based sample of 560 elders in MOBILIZE Boston Study I selected pain qualities to describe how their pain may feel from 3 categories: cognitive/affective, sensory and n...

Malnourishment among older people is growing rapidly in Thailand. It is caused by aging process, inadequate access to food, and financial support. This study was to identify sociodemographic factors, chronic conditions, and health factors associated with the nutrition status among Thai community-dwelling older adults. This was a cross-sectional stu...

We aimed to examine the risk for disability as per Late Life Function and Disability Instrument (LLFDI) scores over 2 years among older adults based on mobility limitation and cognitive impairment status at baseline. Participants were classified according to gait speed (SLOW, if less than 0.8 m/s) and Mild Cognitive Impairment (MCI, based on neuroc...

Background The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care for predicting future disability. We aimed to identify the leg neuromuscular attributes to be targeted in rehabilitative care among older adults with poor SPPB scores. Methods Boston Rehabilitative Impairment Study of the Elderly (Boston RIS...

This mixed methods study evaluated student and provider attitudes and expectations about offering students online access to their student health services visit notes (open notes). Six (N=6) health care providers from four public universities in northeastern Massachusetts participated. Qualitative interviews were completed by students (N=14) from on...

Older adults frequently report pain; cross-sectional studies have shown that pain is associated with worse cognitive function. However, longitudinal studies are lacking. We prospectively studied 441 participants without dementia, including 285 with pain, aged 65 years and older, enrolled in the Central Control of Mobility in Aging Study, a prospect...

Background This study aims to test whether persistent pain quality is associated with incident or worsening disability in four domains: mobility, ADL and IADL difficulty and physical performance. Methods From the MOBILIZE Boston Study, a population-based cohort of adults aged ≥70 years, we studied participants with chronic pain who endorsed at lea...

Objectives To examine the cross‐sectional relationship between chronic pain and complex attention in a population of community‐living older adults. Design Prospective cross‐sectional cohort study. Setting Population‐based Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study II. Participants Individuals a...

Background : Clinicians are increasingly sharing outpatient visit notes with patients through electronic portals. These open notes may bring about new educational opportunities as well as concerns to physicians-in-training and residency programs. Objective : We assessed anticipatory attitudes about open notes and explored factors influencing res...

Background: Poor oral care can contribute to periodontal disease (PD) which affects about half of the U.S. population. With evidence showing periodontal disease can contribute to cardiovascular disease, concerns arise around the risk for periodontal disease from retaining wisdom teeth in adulthood. It is not clear whether presence of wisdom teeth (...

Background: Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes ("OpenNotes") may help close the safet...

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and dis...

Background Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. Methods The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studie...

The non-lab Framingham algorithm, which substitute body mass index for lipids in the laboratory based (lab-based) Framingham algorithm, has been validated among African Americans (AAs). However, its cost-effectiveness and economic tradeoffs have not been evaluated. This study examines the incremental cost-effectiveness ratio (ICER) of two cardiovas...

Aim: A national survey was conducted to examine the relationship between individual students' experiences and nursing PhD program characteristics and program outcomes. Background: In light of the shortage of doctorally prepared nurse scientists and a growth in nursing PhD programs, an examination of the PhD nursing education experience in relati...

Methods: A cross-sectional study of 127 community-dwelling adults aged 67-99 years was conducted. An electronic gait walkway was used to assess gait coordination, measured as the Phase Coordination Index during normal speed walking. A motion capture system was used to assess rhythmic interlimb antiphase ankle coordination, measured as the standard...

Background: Nonlaboratory-based (non-LB) algorithms have been developed to facilitate absolute cardiovascular risk assessment in resource-constrained settings. The non-LB Framingham algorithm, which substitute BMI for lipids in laboratory-based Framingham, exhibits best performance among non-LB algorithms. However, its external validity has not be...

With aging, walking becomes more and more of a conscious effort. Chronic pain in older adults contributes to gait limitations and falls possibly by drawing attention away from the task of walking, leading to slow gait and gait variability. We studied 249 adults aged 71-99y (mean=83.9y, 64.7%female) in the MOBILIZE Boston Study II to evaluate the po...

Chronic pain is associated with a decline in physical function and an increased risk of falls in older adults. This study examined the effects of Tai Chi on pain severity, pain interference and physical function in older adults with multisite pain. Fifty-four community-dwelling older adults with multisite pain who reported falling in the past year...

The identification of novel targets that are risk factors for mobility limitations may improve the ability to prevent and treat mobility impairments among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults. We conducted a 1-y...

Multi-morbidity contributes to functional decline among older adults. However, it is not evident whether specific patterns of multi-morbidity are associated with worse disablement outcomes. We analyzed baseline data from the Boston RISE study, a cohort of older primary care patients with mobility limitations, to examine the association between mult...

Cognitively stimulating activities can improve both cognitive and physical function. Foot reaction time, a test of neuromotor performance and a possible risk factor for falls in older adults, might be influenced by participation in cognitively stimulating activities. The aim of this cross-sectional study was to examine the association between cogni...

Chronic pain often leads to psychological symptoms and physical disability, affecting the lives of many older adults. Pain catastrophizing, potentially treatable, may have an important role on the pathway from chronic pain to its disabling consequences. This secondary analysis examines cross-sectional associations between pain characteristics and p...

It is commonly understood that cognition and mobility are in dynamic feedback, but the role of specific aspects of neuromuscular functioning in driving this association has gone unexplored. We used data from Boston RISE (n=422; age=76.5 ± 7.0; 68.3% female; 17.3% non-white; SPPB score=8.7 ± 2.3) to evaluate the contribution of four neuromuscular at...

Fear of falling (FOF) can contribute to avoidance of physical activity and subsequent adverse health effects, reducing quality of life in older adults. An understanding of potential gender differences in factors such as pain and physical performance as contributors to FOF may lead to better fall prevention in women and men. We studied 765 adults ag...

Accumulating evidence supports that chronic pain is associated with poorer cognitive function and mobility, and fall risk in older adults. This study investigated the feasibility of a randomized controlled trial of a Tai Chi intervention in older adults with multisite pain who are at risk for falls. Adults aged ≥65y with multisite pain (≥ 2 sites)...

Purpose: The purpose of this study was to examine the associations between different physical activity (PA) domains, PA recommendations, and leukocyte telomere length (LTL) using data from a nationally representative sample of U.S. adults in the National Health and Nutrition Examination Survey (NHANES), 1999-2002. Methods: A total of 6,933 U.S....

Background/purpose: Among people aged 65 and over in US, about one in five are edentulous. Tooth loss and edentulism not only interfere with nutritional intake, but also cause discomfort and negatively impact self-esteem and quality of life. As a health issue, tooth loss is a preventable problem that can be addressed by nurses. In recent years, sel...