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Researchers know our social lives are important to our health, with a lack of relationships linked to heart disease, depression and risk of infection. And, as Y. Claire Yang, PhD, has found, how cancer patients view their social relationships could be a matter of life and death.

UNC Lineberger’s Y. Claire Yang, PhD.

As a medical sociologist, Yang is interested in how the quality of social relationships – or lack thereof – can contribute to our health or place us at risk for disease in every stage of life, from childhood to adulthood to old age.

Her research combines biology, statistics and sociology in order to study the quality or quantity of people’s social relationships and risk for cancer and other diseases.

“The overarching theme of my work is to look into mechanisms underlying social disparities in health and their changes over the lifespan,” said Yang, who is a researcher with the University of North Carolina Lineberger Comprehensive Cancer Center and a professor in the Department of Sociology at UNC-Chapel Hill.

From liberal arts to sociology: Finding the right path

Yang has had a longstanding interest in health. Growing up in China’s Sichuan province, she talked to her parents about health often.

“I was always obsessed with health and aging; it was always a theme in my life, and I was thinking about medical school and being a doctor instead,” she said. “But opportunities occur in ways you don’t anticipate.”

As the top-ranked student in her province, Yang was awarded a national scholarship to study liberal arts at Beijing University. She majored in Chinese language and literature, but she found that she wasn’t satisfied. Her studies didn’t align with her interests and natural curiosity.

“I got really unsatisfied on that path because I feel obliged to put numbers on things. I like to quantify,” she said. “I like to compute risk and uncertainty; I like to inquire about hypotheses.”

Yang went on to study sociology at Ohio State University, drawn to a field that uses the scientific method, statistics and data to answer questions. Her experience living in the United States and China sparked an interest in studying social structure and social change. She earned a master’s degree in sociology at Ohio State and a master’s degree in statistics and a doctorate in sociology and demography from Duke University.

In medical sociology, Yang saw an opportunity to prevent disease.

“You’ve got to eat right, you’ve got to exercise, you’ve got to do 10,000 steps,” she said. “What’s missing in this picture is: What will put people in a position to know these things from the very beginning? And that has to do with the environment you grew up in as a child and (whether you have) good friends to hang out with – your social environment.”

Yang is studying social factors that contribute to risk for disease with the goal of identifying changes people can make before they develop a disease.

“By looking at the social patterns for these different kinds of health outcomes and studying what places us at risk for those diseases in the first place, we have the upper hand in terms of prevention because we study factors that happen prior to people’s actual onset of disease, as opposed to worrying about what happens after they get it and have come to the doctor,” she said.

How do social relationships ‘get under the skin’ to impact disease risk?

After she finished her doctorate, Yang became an assistant professor of sociology at the University of Chicago. In 2008, she published a paper in the American Sociological Review on happiness across the lifetime. She found in a review of 32 years of survey data that people’s happiness increased about 5 percent for each 10 years in adulthood.

Those findings were a surprise to her, but the biggest surprise of her career came later when she entered the field of cancer research.

After she came to UNC-Chapel Hill as an associate professor in 2010, Yang received awards from the National Institute on Aging. The grants have allowed her to investigate biological mechanisms underlying the link between social status and risk for chronic diseases of aging, including cancer.

Now, that’s her focus.

“I’m interested in how social relationships and connections get under the skin to affect people’s risk of cancer, and probability of survival once they have cancer,” she said.

Getting under the skin

In a 2016 study published in the Proceedings of the National Academy of Sciences, Yang and her colleagues were the first to definitively link social relationships with concrete measures of physical well being, such as abdominal obesity, inflammation and high blood pressure. These measures have long-term health implications, including for cancer risk.

Their research showed that the more social ties a person has at an early age, the better their health is at the beginning and end of their lives.

“Our analysis makes it clear that doctors, clinicians and other health workers should redouble their efforts to help the public understand how important strong social bonds are throughout the course of all of our lives,” she said.

In another study, published last year in Cancer Epidemiology, Biomarkers and Prevention, Yang and her team’s analysis of questionnaires and blood biomarker data from more than 1,000 cancer survivors revealed that the perception of social support linked to survival outcomes.

Cancer patients who reported higher levels of satisfaction with their social support had a lower risk of death.Yang and her colleagues believe patient satisfaction for social support could be related to lowered inflammatory responses.

“We found that the subjective satisfaction of social support turns out to be significant for cancer survival,” she said. “We need to promote awareness that social connections are important for survival for cancer. We need to make sure [patients] have they support they need.”

Surprisingly, the study found that the amount of support patients received was not linked to cancer survival.

“We didn’t anticipate that social satisfaction would be more important than the actual receipt of support,” Yang said. “Monitoring patients’ self-appraisal of satisfaction to keep in touch with their own perceptions of the adequacy and quality of their support would be something highly doable from a health care perspective.”

She said that cancer research was the newest chapter of her career, but she said it’s been “tremendously broadening and life changing.” If she wasn’t a researcher, she said she would be helping people manage pain associated with chronic diseases of aging.

“I would be a kind of doctor, but a different kind of doctor,” she said.

In her free time, she enjoys competitive ballroom dancing. She recently took her son to visit China, where she tries to visit each year to see her family.