Prevalence and Correlates of Social Risks and Receipt of Resources Among Rural and Urban Veterans

Rural Veterans face barriers to accessing clinical care and community-based services, often exacerbated by social needs. Assessing Circumstances and Offering Resources for Needs (ACORN) is a Veterans Affairs (VA) healthcare system, Veteran-tailored intervention to screen for social risks (e.g., food insecurity, social isolation) and address social needs. We examined rural-urban differences in social risks and receipt of resources/referrals.

This was a retrospective, cross-sectional evaluation using VA administrative data for Veterans screened with ACORN between January 2024 and September 2025. Veterans were screened for social risks across nine domains and offered resources/referrals to address needs. Multivariable logistic regression models were estimated to identify associations between rurality, social risks, and receipt of resources/referrals.

During the evaluation period, 92,017 Veterans across 87 VA sites were screened with ACORN; 29.37% were rural (n = 28,346). Overall, 60.30% of Veterans reported one or more social risks (55.65% rural vs. 62.37% urban, p < 0.001). Rural Veterans were less likely to endorse all social risks except for digital needs (21.16% vs. 20.27%, p = 0.002). In adjusted models, rural Veterans had lower odds of reporting one or more social risks (aOR, 0.85; 95% CI, 0.76-0.94). Among those screening positive, rural Veterans were less likely to receive resources/referrals (aOR, 0.89; 95% CI, 0.85-0.94) or report already receiving services/assistance (aOR, 0.85; 95% CI, 0.76-0.95), and more likely to decline assistance (aOR, 1.27; 95% CI, 1.17-1.37).

Rural Veterans were less likely to report social risks than urban Veterans. However, among those screening positive, rural Veterans were less likely to receive assistance. Future work is needed to understand rural Veterans' experiences with social risks and differences in receipt of resources/referrals.