Protecting Nurses During Pregnancy: Cross-Sectional Study of Workplace Exposures and Modifications.

Rural Americans have a rich history of US military participation and volunteer for military service at higher rates than their urban counterparts []. This heterogeneous population experiences both challenges and strengths related to the intersection of military service and rural residence []. Military participation elevates risk for many physical and mental health conditions (e.g., musculoskeletal disorders, post‐traumatic stress disorder), and rural residence is associated with higher rates of chronic conditions (e.g., heart disease, stroke) and healthcare access barriers [, , , ]. While only 20% of US residents live in rural areas, rural veterans constitute almost 33% of the 9 million veterans enrolled in the Veterans Health Administration (VHA), the nation's largest integrated healthcare system [, , ]. Defining “rural” is complex given that rural areas are characterized by immense heterogeneity in landscapes, local norms and values, and economic structures []. While rurality can be associated with characteristics like geographic isolation and low population density, it is not solely defined by these factors []. Yet, the most frequently used definitions of rurality, based on US Census Bureau's and Office of Management and Budget's classification systems, are geographic‐based definitions that label rural areas as those that are not urban or metropolitan [, ]. No uniform definition of rurality has been adopted across the federal government [], and attempts to define rurality are driven by specific intentions of the users []. As a result, there are meaningful differences in who is characterized as rural when comparing common definitions of rurality []. These differences matter because how rurality is defined has clear implications for who is eligible for rural‐focused programs designed to enhance access to healthcare []. Further, relying on geography alone to characterize rurality, particularly when using rural–urban dichotomies, may mask other underlying factors that have important implications for healthcare access like the availability of local healthcare providers and access to healthcare resources in surrounding areas [, ]. Within VHA, the definition of rurality informs both how healthcare is delivered and how funds are allocated to support advancements in care. The VHA Office of Rural Health (ORH), whose mission is to “honor America's rural veterans by providing exceptional healthcare that improves their health and well‐being,” funds research, quality improvement, and other programs or initiatives that strengthen rural veterans’ health and expand their healthcare access []. A critical part of allocating ORH funds involves determining which initiatives have the greatest impact, a process that requires a clear definition of rurality for both individuals and locations of care.