ABERDEEN PROVING GROUND, Md. -- The U.S. Army Public Health Center recently released its fourth edition of the Health of the Force report. The report makes Soldier health and readiness information accessible to a wide array of stakeholders, including military medical professionals, Soldiers, and the larger community.The 2018 product line includes a digital dashboard interface allowing readers to drill down into available data so they can make informed decisions that ultimately improve Soldier readiness, health and well-being."The health of the Soldier is the foundation of our Army's ability to deploy, fight and win," said Ginn White, Health of the Force product manager. "Health of the Force facilitates a healthier force for tomorrow by providing an evidence-based portrait of the health and well-being of the Army."The report identifies any health-related issues of concern. Some areas of focus for this year's study were behavioral health diagnosis rates, smoking and tobacco use, obesity, and sexually transmitted infections, which have been on the rise since 2013. The report also looked at recent examples of potential impact of air quality on the breadth of medical readiness topics from training to chronic disease.According to the Health of the Force report, injuries remain a key factor impacting readiness. Fifty-six percent of Soldiers reported a new injury in 2017 and 71 percent of those injuries were cumulative musculoskeletal or "overuse" injuries. The report also found incidents of injuries were higher for older Soldiers (age 45 and over) and women.The report uses available 2017 medical, wellness and environmental data to examine Soldier health through the prism of the Performance Triad of sleep, activity and nutrition."It's the goal of the Performance Triad to enable leaders to set conditions for Soldiers to optimize their sleep, activity and nutrition to improve the overall readiness of the Army," said Col. Hope Williamson-Younce, director of the Army System for Health Directorate.According to the Health of the Force report, only one in three Active Component Soldiers are reaching the target of seven hours of sleep on weeknights or duty nights."Just one sleepless night (less than four hours) can impair performance as much as a blood-alcohol level of 0.10 percent," said Williamson-Younce. "Five days with less than five hours of sleep per night or going one day without sleep are correlated with a 20 percent decrease in cognitive ability."Williamson-Younce said one of the recommended strategies for combatting sleep deprivation is to use sleep banking as a way of preparing for a planned field training exercise or a short one to two-week mission.At Fort Riley, sleep banking was put into practice by an armored brigade combat unit, said Williamson-Younce. Prior to a weeklong FTX for gunnery tables, Soldiers attended a sleep education session and participated in a "reverse PT schedule," during which the Soldiers arrived at 9 a.m. and conducted PT at 4 p.m. This led to dramatic improvements in their Gunnery Table results. They went from an average score of 756 (qualified) without banking to an average score of 919 (distinguished) with sleep banking.Positive mental imaging is another strategy for improving performance spotlighted in the 2018 Health of the Force report. Occupational therapy health teams are teaching behavior skills, including the use of mental imagery, positive self-talk, heart rate control and goal setting during unit physical training to provide the winning edge.Col. Vanessa Meyer, chief of Occupational Therapy at Fort Belvoir Community Hospital, developed a successful program of teaching mental skills techniques used by elite professional athletes to Soldiers for improved fitness scores. These techniques are highlighted in an Annual Physical Fitness Test mental skills quick reference card for Soldiers seeking "Mental Skills for Peak Performance.""Many young Soldiers today enter service without any formal sports training experience and have never learned to train the mind as well as the body," said Meyer, who runs a Fort Belvoir program for service members to maximize their fitness performance.Meyer, whose research was also published in the 2018 Military Medicine journal, showed how just six weeks of training in her mental skills program helped Soldiers add 13-14 points to their APFT scores."Embedding mental skills training in daily physical fitness activities has dramatically improved their performance," said Meyer. "Teaching these skills early on translates into a lasting positive effect throughout their careers."Another key finding in the 2018 Health of the Force report is the value unit embedded health teams bring toward combatting behavioral health issues. Although 15 percent of Soldiers have a behavioral health diagnosis, EBH teams have made statistically significant improvements in mission readiness, increased outpatient BH care and a reduction in the need for acute inpatient psychiatric care.According to the Health of the Force report, EBH teams serve as the "single point of entry" into BH care and are typically located within walking distance of where Soldiers live and work."Leaders have consistently reported high satisfaction levels regarding their interaction with EBH teams, services provided, and the quality of care Soldiers receive," said Latoya Johnson, a comparative health outcomes researcher for the Army Public Health Center.Senior Army leaders are using the Health of the Force report to further understand the health of their communities and to improve the environment, infrastructure and nutrition on their installations. In addition to data highlighting challenges and successes, the report includes brief narratives describing the latest advancements in injury and disease prevention and mitigation. The report provides meaningful data for senior Army leaders to create cultural and programmatic change in support of the total Army's overall readiness and health."Health of the Force provides the opportunity for a meaningful dialogue around what matters most to a fully functioning, healthy, ready force," said White. "It contextualizes the information to allow leaders at all levels to identify strengths, analyze vulnerabilities, and take action."John Resta, director of the U.S. Army Public Health Center and acting deputy chief of staff of Public Health for the U.S. Army Medical Command, stated that "in support of total Army readiness, the Health of the Force report continues to provide meaningful data and information through rigorous research and analyses."Readers are encouraged to provide feedback or seek more specific consultative services by contacting the APHC Health of the Force team through the "Contact Us" button on the APHC Health of the Force website, which also provides links to all previous year reports.--30--The Army Public Health Center enhances Army readiness by identifying and assessing current and emerging health threats, developing and communicating public health solutions, and assuring the quality and effectiveness of the Army's Public Health Enterprise.