Digital Commons Network^™

Medical Debt Among Low-Wage Workers In The United States: Reason To Worry And Reason To Hope, Mathieu Despard, Stephen Roll, Eva Stahl, Camila Salvagno

Center for Social Development Research

With one in five low-wage workers reporting medical or dental debt they cannot afford to pay, financial assistance programs (also known as charity care) are an important resource. Federal law requires nonprofit hospitals to offer such programs, but evidence suggests that workers experience administrative burdens in learning about and applying for the assistance. Drawing upon data from the Workforce Economic Inclusion and Mobility (WEIM) survey, this brief presents findings on associations between the characteristics of low-wage workers and their experiences with financial assistance programs. The brief also shares examples of how hospital policies and patients’ needs may not align, presenting …

Gene-Environment Interactions In Cardiovascular Aging: Volunteering, Polygenic Risk, And Biomarker Change In European And African Ancestry Populations, Seoyoun Kim, Byeongju Ryu, Erin Ware, Koichiro Shiba, Cal J. Halvorsen

Brown School Faculty Publications

Volunteering has been associated with better cardiovascular health, but whether this association varies by genetic susceptibility to cardiovascular disease remains unclear. This study examined associations between volunteering and cardiovascular biomarkers, assessed associations between biomarker-specific polygenic scores (PGSs) and these outcomes, and tested whether polygenic risk moderated volunteering–biomarker associations among U.S. adults aged 51 years and older.

Universal Child Development Accounts In Taiwan: Recent Policy Developments, I-Feng Chen, Jin Huang, Michael Sherraden

Center for Social Development Research

On July 24, 2026, Taiwan’s legislature passed the Taiwan Future Account Special Act. If signed into law, the bill would create a national Child Development Account policy with many of the features that research has identified as key design elements for universal children’s account policy. This brief examines the bill and competing proposals, comparing the design elements with features in the Trump Account policy. The brief also details three recommendations for strengthening the policy.

Hospital Charity Care And Medical Debt Among Low-Wage Workers In The United States, Mathieu Despard, Stephen Roll, Eva Stahl, Camila Salvagno, Ruth Lande

Center for Social Development Research

With one in five low-wage workers reporting medical or dental debt they cannot afford to pay, financial assistance programs (also known as charity care) are an important resource. Federal law requires nonprofit hospitals to offer such programs, but evidence suggests that workers experience administrative burdens in learning about and applying for the assistance. Drawing upon data from the Workforce Economic Inclusion and Mobility (WEIM) survey, this brief presents findings on associations between the characteristics of low-wage workers and their experiences with financial assistance programs. The brief also shares examples of how hospital policies and patients’ needs may not align, presenting …

Coping With Adversity: Exploring The Role Of Protective Factors And Their Impact On School Enrollment And Satisfaction Among Adolescents Living With Hiv In Low-Resource Settings, Jennifer Nattabi

Brown School Graduate Student Theses and Dissertations

Globally, an estimated 2.38 million children and adolescents (0–19 years) are living with HIV, with 80% residing in sub-Saharan Africa. In Uganda, adolescents remain at high risk, with approximately 6,600 new infections among 10–19-year-olds in 2023. Despite expanded access to antiretroviral therapy (ART), adolescents Living with HIV (ALHIV) continue to experience poor outcomes, including low viral suppression and high mortality, largely driven by non-adherence. However, ART adherence represents only one dimension of their lived experience. ALHIV must also navigate intersecting adversities, including poverty, stigma, orphanhood, and exposure to sexual and gender-based violence, while meeting academic expectations, particularly in boarding school …

The Most Age-Diverse Society In Our Country's History, Cal J. Halvorsen, Logan Fox, Tim B. Zielonko

Harvey A. Friedman Center for Aging

The public narrative is that the United States population is getting older. This is, indeed, true. We have more people over age 50 than we have ever had in our country—both in total numbers and in the share of the population. The numbers of older people will continue to grow, all the way up until the projections stop at the year 2100. Many have asked, “What will we do with all of these older people?”

Data For Social Impact - Data Party Planning Worksheet, Jenrose Fitzgerald, Dan Ferris, Ally Terhaar

Center for Social Development Research

Data party, data walk, gallery walk, and data placemat—All of these tools are variations on a common theme: the importance of working collaboratively with data. This worksheet discusses ways to design, organize, and lead data parties. It also presents resources to facilitate data collaboration.

Data Walks That Drive Results: Using Data To Build Impact, Jenrose Fittzgerald, Sara Mohamed, Kameke Payne

Center for Social Development Research

Urban Strategies, Inc. (USI), works to ensure that every family served is stable, thriving, and progressing across six impact areas: Family and Housing Stability, Education and Careers, Economic Contribution, Health and Wellness, Civic and Community Engagement, and Community Partnerships. Because USI employs over 200 staff members spread across more than 60 community sites, coordinating data to understand impact is both critical to advancing the organization’s work and a challenge. To address this, USI has developed a performance-measurement approach that brings everyone at the organization into the work and builds a sense of ownership at every level: quarterly data walks. This …

Innovations In Financial Services For Low-Wage Workers, Mathieu Despard, Stephen Roll

Center for Social Development Research

The financial services landscape in the United States has shifted dramatically in recent years, with technology driving profound changes. New products and services are emerging in a competitive digital marketplace to meet the basic banking, savings, and short-term credit needs of workers. This brief presents findings from the Workforce Economic Inclusion and Mobility (WEIM) project on the employment and financial circumstances of low-wage workers in the United States and on their use of financial services.

Essential Employer Benefits For Low-Wage Workers, Mathieu Despard, Stephen Roll

Center for Social Development Research

Employer benefits are important for supporting employees’ financial well-being, but are they accessible to low-wage workers? This brief presents findings from a survey conducted for the Workforce Economic Inclusion and Mobility (WEIM) project with low-wage workers in the United States. The findings reveal information on respondents’ access to employer benefits, including health insurance, paid sick leave, a retirement plan, and financial-wellness benefits.

When Getting Ahead Means Falling Behind: Work And Savings Disincentives In Public Benefits, Stephen Roll, Mathieu Despard

Center for Social Development Research

Public benefits help millions of workers meet basic needs such as food, health care, housing, and childcare. But for many low-wage workers, these programs can also create a difficult trade-off: Earning more or saving more can sometimes mean losing the benefits they need to keep their family afloat. This brief summarizes key findings from a survey conducted for the Workforce Economic Inclusion and Mobility (WEIM) project with a nationally representative sample of low-wage U.S. workers. The findings suggest elements of a public benefits system that could protect families from economic risk while supporting work, savings, and long-term mobility.

When The Safety Net Becomes A Barrier: Administrative Burdens In Snap And Medicaid, Stephen Roll, Mathieu Despard

Center for Social Development Research

The goal of the U.S. social safety net is to ensure that everyone can meet a basic standard of living, regardless of their economic, health, or life circumstances. The Supplemental Nutrition Assistance Program (SNAP) and Medicaid, two key parts of this safety net, support low-income families in affording food and health care. This brief summarizes findings on seven dimensions of administrative burden in SNAP and Medicaid. The findings come from analyses conducted with data from the Workforce Economic Inclusion and Mobility Project’s survey of a nationally representative sample of low-wage U.S. workers. They suggest that administrative burdens are common, affect …

Paths To Stability And Wealth: Evidence From The Habitat For Humanity Wealth Building Project, Yung Chun, Somalis Chy, Laura Evans, Xueying Mei, Stephen Roll

Center for Social Development Research

Owning a home has long been the most common way for American families build wealth—but for low- and moderate-income families, the route is rarely open and rarely simple. And handing a family the keys does not guarantee that the house will become an asset. This report sets out to answer a hard question: Can homeownership deliver lasting wealth to the families who have been locked out of it the longest, and what does it take to make that happen? This study presents findings from the first national evaluation of the Habitat for Humanity Wealth Building Project. The report examines how …

Community Programs That Build Connection, Jihye Baek, Cal J. Halvorsen

Harvey A. Friedman Center for Aging

Social connection is a fundamental human need and a critical driver of individual health and well-being. When older adults maintain stable, supportive relationships, they experience significantly better physical, mental, and cognitive health outcomes. In response to growing evidence of its public health impact, the World Health Organization (WHO) designated social connection as a global public health priority, and the U.S. Surgeon General issued an Advisory calling for action to address the loneliness epidemic.

Beyond The Generations: Building A High-Quality Workplace For An Age-Diverse Workforce, Cal J. Halvorsen, Bruna C. Lopez, Erika Sabbath

Brown School Faculty Publications

At a time when the U.S. is more age diverse than ever before, Americans are extending their careers for financial stability, social connection, and purpose. This article provides a brief background on the history of aging and work, from the late 1800s to present, illustrating the influence that public and organizational policies, as well as personal needs and interests, have on labor force participation. It then provides examples for how employers can create better workplaces for people of all ages, concluding with the case for why more age-inclusive workplaces lead to better results for employees, their families, and their employers.

Evidence-Based Child Development Account Elements And The 530a Account Design, Jin Huang, Michael Sherraden, Lissa Johnson, Margaret Clancy

Center for Social Development Research

Drawing on the 10 evidence-based CDA design elements identified by Sherraden, Clancy, and Beverly, this brief examines the points at which 530A Accounts align with, partially meet, or fall short of the design standards that evidence shows are necessary for a universal and effective children’s account policy.

“We Try To Act So Progressive”: A Multivariate And Interpretive Methods Study Examining Equity, Racialization And Interrelated Systems Of Oppression And Privilege Within Hiv Service Organizations, Gregory Joseph Gross

Brown School Graduate Student Theses and Dissertations

Current data suggests that the U.S. is on track to end the HIV epidemic for white people but not for Black, Latine, and other people of color. National initiatives have emphasized diversifying the workforce as part of the response to inequities in HIV outcomes, and yet the field remains staffed predominantly by white service professionals. Moreover, diversifying the workforce without broader systems change will likely be insufficient to address inequities both for professionals and for oppressed communities. The goal of this dissertation was to examine racialization and interrelated systems of privilege and oppression within HIV service organizations, including public health …

Center For Social Development Report To The Community: 2026, Center For Social Development, Washington University In St. Louis

Center for Social Development Research

For more than 30 years, the Center for Social Development (CSD) has been a hub for implementing and testing applied social innovations. As the 2026 "Report to the Community" underscores, we remain dedicated to our mission to advance policies and practices that support individuals, families, and communities in achieving their goals and contributing to society and the economy.

Comments On Proposed Regulations Reg-117270-25: Trump Accounts Under Section 530a, Jin Huang, Margaret Clancy, Michael Sherraden, Lissa Johnson, Stephen Roll

Center for Social Development Research

In December 2025, the U.S. Treasury Department published a notice of intent to issue regulations concerning Trump Accounts (also known as 530A accounts), requesting public comments on proposed regulations for the Trump Accounts Contribution Pilot Program. This testimony presents comments submitted n response. Drawing on decades of Child Development Account research, including insights from the SEED for Oklahoma Kids experiment (SEED OK), the authors urge Treasury to adopt automatic enrollment to ensure that all eligible children— not only those whose families actively enroll them—receive the $1,000 pilot-program contribution. They outline federal–state implementation pathways using Social Security number data, recommend layered …

Enhancing The Well-Being Of Refugees With Disabilities Through Equitable Access To Essential Services: A Participatory Qualitative Study In The United States, Mustafa Rfat

Brown School Graduate Student Theses and Dissertations

Access to services for refugees with disabilities (RwDs) is critically important for improving their well-being and enhancing their integration. This population often faces prolonged exclusion that begins in their country of origin and often continues to worsen during displacement, leading to accumulated disparities. Because the United States (U.S.) refugee program is structured around rapid employment, refugees who do not fit the fast-track employment criteria are often left behind. RwDs are often considered unemployable, which automatically shifts resources and services away from them. Abandoning RwDs during the critical period of resettlement puts them at heightened risk of increased and long-term exclusion. …

Early Postsecondary Use Of Assets In Seed Ok: Cda Distributions Through 2025, Jin Huang, Margaret Clamcy, Mark Schreiner, Lissa Johnson, Michael Sherraden

Center for Social Development Research

The SEED for Oklahoma Kids experiment (SEED OK) is a large-scale policy test of universal, automatic, and progressive Child Development Accounts (CDAs). In late 2007, each newborn in the experiment’s treatment group received a CDA seeded with a deposit of $1,000. This brief presents the first findings on the distribution of funds from those accounts.

Comments On Proposed Regulations Reg-117002-25: Trump Accounts Contribution Pilot Program, Jin Huang, Margaret Clancy, Michael Sherraden, Lissa Johnson, Stephen Roll

Center for Social Development Research

In March 2026, the Internal Revenue Service announced issued a notice of proposed rulemaking on the Trump Accounts Contribution Pilot Program and solicited comments on the proposed regulations. This testimony presents comments submitted in response to that call. The comments focus specifically on auto¬matic enrollment as addressed in the proposed regulations and provide recommendations for regulatory amendments to imple¬ment automatic enrollment within the existing legal framework for 530A accounts (known as Trump Accounts).

National Fund For Children In Kazakhstan: Vision And Purpose, Askhat Aimagambetov

Center for Social Development Research

This Perspective presents the address given by Askhat Aimagambetov, honorable member of the Majilis of the Parliament of the Republic of Kazakhstan, on the occasion of “The National Fund for Children of Kazakhstan: Policy Innovation and Potential for Global Impacts,” an international symposium held at Maqsut Narikbayev University in Astana, Kazakhstan, on October 30, 2025. The Center for Social Development is honored to publish his remarks.

Choice, Power, & Care: Crisis Pregnancy Centers And Reproductive Justice In Missouri, Sylvie Richards

Women, Gender, and Sexuality Studies Senior Honors Papers

Crisis pregnancy centers (CPCs) are religious organizations with the purpose to dissuade people from obtaining abortions. They often present themselves as authentic reproductive healthcare clinics through medicalized language, services such as ultrasounds and pregnancy tests, promises of information on all pregnancy options, staff dressed as medical professionals, and placement near family planning clinics. In reality, CPCs are medically unlicensed and often spread medical misinformation.

No study has yet focused on CPCs in Missouri, despite providing a critical case study. The state has minimal access to abortion and other components of comprehensive reproductive healthcare and one of the worst maternal mortality …

Intimate Partner Violence And Couples Who Practice Power Exchange: Exploring Discussions Of Harm In Bdsm Writing, Delilah Tefertiller

Women, Gender, and Sexuality Studies Senior Honors Papers

The current tools and services available for those who have experienced intimate partner violence (IPV) center power and control as negative influences that lead to coercive control (Stark, 2007) and harm. However, the BDSM and kink community negotiate and play with power dynamics in ways that defy current ideas about "healthy relationships." There is, therefore, little known about the perspectives of those who experience IPV in BDSM contexts. Additionally, current IPV tools are not adapted to fit a community that views power differently. A content analysis of BDSM 101 texts—a subgenre of BDSM literature that introduces and educates newcomers about …

Mental Health In Rural School-Age Youth: Examining Trends In Adverse Childhood Experiences, Positive Childhood Experiences, And Family Resilience From 2018-2023, Mary Katherine Shires

Brown School Graduate Student Theses and Dissertations

This study examined trends in adverse childhood experiences (ACEs), positive childhood experiences (PCEs), family resilience, and mental health conditions in rural and urban youth in the United States from 2018-2023. It also assessed whether PCEs and family resilience moderated the association between ACEs and youth mental health and whether these relationships differed by geographic setting and across time. Data were drawn from six years (2018-2023) of the National Survey of Children’s Health (NSCH), a nationally representative, cross-sectional, caregiver-reported survey assessing child wellbeing. The analytic sample included school-age youth (ages 6-17) residing in states that reported metropolitan (urban) versus non-metropolitan (rural) …

Adaptation And Initial Validation Of The U.S. Census Multidimensional Deprivation Index For Resettled Afghans, Mitra Naseh, Saria Bechara, Yingying Zeng, Jihye Lee, Miriam Potocky

Forced Migration Initiative

This working paper describes the adaptation, pilot testing, and initial validation of the U.S. Census Bureau’s Multidimensional Deprivation Index (MDI) for use among resettled Afghan refugees. The adaptation process included a scoping review, a qualitative descriptive study, and consultation with a community advisory board. The adapted index was subsequently pilot tested among 336 resettled Afghan households in the United States. Results indicate high rates of deprivation across all seven domains of the adapted MDI. Notably, employment and career mobility domain showed limited association with other domains, confirming the emerging evidence that employment alone no longer could be an indicator of …

Child Development Accounts Reduce Adolescent Behavior Problems, Jin Huang, Yingying Zeng, Michael Sherraden

Center for Social Development Research

Adolescence can be a challenging time, and a body of research has investigated options for addressing adolescent behavior problems. This brief presents findings from a new line of inquiry. The analyses presented here draw upon data from the SEED for Oklahoma Kids experiment, a test of a statewide Child Development Account (CDA) policy in Oklahoma. The findings indicate that CDAs positively shape the frequency of adolescent behavior problems.

Comments On Treasury Notice 2025-68, Jin Huang, Michael Sherraden

Center for Social Development Research

In December 2025, the U.S. Treasury Department and the Internal Revenue Service announced their intent to issue regulations concerning Trump Accounts (also known as 530A accounts), requesting public comments on the intended regulations and related provisions. This testimony presents comments submitted in response to that request. In it, Jin Huang and Michael Sherraden summarize evidence from the SEED for Oklahoma Kids experiment (SEED OK), Maine’s My Alfond Grant, and Rhode Island’s CollegeBound Baby on the effectiveness of automatic enrollment in policy. They discuss the use of Social Security numbers, a centralized clearing fund, and a designated custodian network as tools …

How Disaster Risk Shapes Voter Turnout, Laura Brugger, Pedro Spindler-Ruiz, J.S. Onesimo Sandoval

Center for Social Development Research

Climate disasters are intensifying. With the intensification comes a growing threat to democracy in the United States and to the communities that depend on fair representation. When disaster strikes, barriers arise that can silence voters, especially in communities already facing systemic inequality. This brief presents findings from an analysis of precinct-level turnout in the 2020 U.S. presidential election across over 2,000 precincts in the three cities. The cities were chosen for their size, diversity, and exposure to climate threats: hurricanes in Miami, Florida, wildfires in Los Angeles, California, and flooding in San Antonio, Texas. The findings underscore the need to …