Army National Guard Research Articles

Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points.

The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments. Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737). In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).

Embedded behavioral health providers: an assessment with the Army National Guard.

Although the Army has recently begun the practice of embedding behavioral health care providers (EBHP) in units in an effort to improve soldier well-being, the efficacy of this practice has not been evaluated. This study assesses 1 of the first programs implemented by the military. Using cross-sectional data obtained from a confidential survey of 12 company-level units in the California Army National Guard (n = 1,132), this study examines differences between units with and without EBHPs across a number of measures. Multilevel analysis of behavioral health symptoms, unit climate, perceptions of stigma, and practical barriers to care failed to detect main effects between units with EBHPs relative to those without. However, cross-level interactions were detected between unit EBHP status and soldiers reporting close relationship (e.g., spouse, girlfriend/boyfriend) impairment. Exploratory findings suggest that, among soldiers reporting close relationship impairment, those belonging to units with EBHPs reported significantly lower behavioral health symptoms and significantly more positive unit climates. Based on these limited exploratory finings, this study suggests that EBHPs in reserve units may have a positive effect on a subset of soldiers (i.e., those reporting close relationship impairment). More assessments of embed programs should be conducted, particularly using prospective longitudinal data among randomized units.

Potentially modifiable deployment characteristics and new-onset alcohol abuse or dependence in the US National Guard

BackgroundThere is a limited amount of data examining the relation between the onset of alcohol abuse/dependence and the experiences of soldiers prior to (pre), during (peri) and after (post) military deployment. Some deployment characteristics, e.g., military unit cohesion, are potentially modifiable in the context of reducing alcohol abuse/dependence peri-/post deployment. We investigated the associations between potentially modifiable deployment characteristics and peri-/post (incident) alcohol abuse/dependence among deployed Ohio Army National Guard (OHARNG) soldiers. MethodsUsing a sample of OHARNG (June, 2008 to February, 2009), eligible participants were ever been deployed and did not report alcohol abuse/dependence prior to deployment (final sample size=963). Interviews assessed soldiers’ alcohol abuse/dependence, depression, PTSD, deployment related factors (e.g., exposure to warzone stressors) and three deployment characteristics (pre-deployment preparedness, unit support during deployment, and post-deployment social support). Associations between the three deployment characteristics and incident alcohol abuse/dependence (defined as abuse or dependence at any point during or after deployment) were estimated using logistic regression. ResultsOnly pre-deployment preparedness was associated with incident alcohol abuse/dependence (a non-linear inverted-u shaped relation) when controlling for demographics, deployment related factors (e.g., exposure to warzone stressors), and the presence of psychopathology that exhibited peri-/post-deployment. We present these results graphically, plotting incident alcohol abuse/dependence over the levels of pre-deployment preparedness. ConclusionsThe association between pre-deployment preparedness and alcohol abuse/dependence may be characterized as an inverted-U shaped function. Suggestions for how and whether to modify pre-deployment preparedness in an effort to reduce peri-/post-deployment alcohol abuse or dependence should await further research.

The incidence of dental disease nonbattle injuries in deployed U.S. Army personnel.

In the past, the U.S. Army Reserve (USAR) and Army National Guard (ARNG) have exhibited lower levels of medical and dental readiness than active duty (AD) Soldiers when activated for deployment. The objective was to compare dental disease and nonbattle injury (D-DNBI) incidence rates and describe the most common D-DNBI diagnoses in Army AD, ARNG, and USAR Soldiers deployed to Iraq (Operation Iraqi Freedom/Operation New Dawn) and Afghanistan or Kuwait (Operation Enduring Freedom). Data from the Center for AMEDD Strategic Studies (CASS) were used to determine D-DNBI encounter rates and diagnoses for deployed Army Soldiers. "Dental Caries" was the leading diagnosis (10.00%) for Soldiers in both theaters. For Operation Iraqi Freedom, D-DNBI rates were highest in 2010 at 144.05 per 1,000 Soldiers per year (AD 135.77, ARNG 151.39 and USAR 183.76). In comparison, D-DNBI rates in Operation Enduring Freedom were highest in 2012 with an overall rate of 85.77 per 1,000 Soldiers per year (AD 72.48, ARNG 129.38 and USAR 129.52). In both campaigns, the data suggest that ARNG and USAR Soldiers had higher D-DNBI rates when compared to AD Soldiers. Further investigation is needed to decrease D-DNBI rates and to determine risk factors that may influence D-DNBI rates among Army components during deployments.

Cortical gamma-aminobutyric acid and glutamate in posttraumatic stress disorder and their relationships to self-reported sleep quality.

To test if posttraumatic stress disorder (PTSD) is associated with low brain gamma-aminobutyric acid (GABA) levels and if reduced GABA is mediated by poor sleep quality. Laboratory study using in vivo proton magnetic resonance spectroscopy (1H MRS) and behavioral testing. VA Medical Center Research Service, Psychiatry and Radiology. Twenty-seven patients with PTSD (PTSD+) and 18 trauma-exposed controls without PTSD (PTSD-), recruited from United States Army reservists, Army National Guard, and mental health clinics. None. 1H MRS at 4 Tesla yielded spectra from three cortical brain regions. In parieto-occipital and temporal cortices, PTSD+ had lower GABA concentrations than PTSD-. As expected, PTSD+ had higher depressive and anxiety symptom scores and a higher Insomnia Severity Index (ISI) score. Higher ISI correlated with lower GABA and higher glutamate levels in parieto-occipital cortex and tended to correlate with lower GABA in the anterior cingulate. The relationship between parieto-occipital GABA and PTSD diagnosis was fully mediated through insomnia severity. Lower N-acetylaspartate and glutamate concentrations in the anterior cingulate cortex correlated with higher arousal scores, whereas depressive and anxiety symptoms did generally not influence metabolite concentrations. Low brain gamma-aminobutyric acid (GABA) concentration in posttraumatic stress disorder (PTSD) is consistent with most findings in panic and social anxiety disorders. Low GABA associated with poor sleep quality is consistent with the hyperarousal theory of both primary insomnia and PTSD. Our data demonstrate that poor sleep quality mediates low parieto-occipital GABA in PTSD. The findings have implications for PTSD treatment approaches.

Prevalence of Childhood Abuse Among Army National Soldiers and Its Relationship to Adult Suicidal Behavior

The present study examined childhood abuse (self-reported early childhood harsh punishment and physical abuse from parents) and its relationship to adult suicidal behavior among Army National Guard soldiers. Analyses of data obtained from routinely administered the Unit Risk Inventory (N = 12,567 soldiers in 180 company-sized units) showed prevalence rates of 16.0% for harsh punishment and 7.8% for physical abuse, generally consistent with those of past studies investigating childhood abuse among civilian and military populations. Soldiers who reported childhood abuse were three to eight times more likely to report suicidal behavior (i.e., thought about suicide, made plans, or had attempted), with the highest likelihood of such behaviors for self-reported physical abuse. Level 2 or unit-level effects were also observed, though the effects were less evident.

Reintegrating National Guard Soldiers After Deployment: Implications and Considerations

U.S. Army National Guard members are serving overseas on deployments at a level well above expectations of reserve service, and successful reintegration of citizen-soldiers postdeployment has become a significant concern. This article examines soldiers’ experiences transitioning postdeployment and offers preliminary observations on one state's Yellow Ribbon Reintegration Program. Data from interviews and participant-observation identified postdeployment experiences in three areas: (1) remembering the positive, (2) dealing with American civilian sociocultural norms and values, and (3) coping with mental and emotional health needs. Data suggest that the social context of reintegration is important and that existing programs may not adequately meet soldiers’ needs.

Poster #M176 MESSENGER RNA AND MICRORNA EXPRESSION PROFILING OF PYRAMIDAL NEURONS, PARVALBUMIN-IMMUNOREACTIVE NEURONS, DOPAMINE NEURONS AND OLIGODENDROCYTES IN SCHIZOPHRENIA AND PARKINSON'S DISEASE

The study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists.Age-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17–60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale.Lifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders – particularly phobias and OCD – having the earliest (median=15 years) and mood disorders the latest median age-of-onset (median=21 years).The study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples.Each psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.

Turning Points and Trajectories in Military Deployment

Previous military family research has assumed a stable set of deployment phases. In line with critiques of such models within family communication, we identified the varied turning points and trajectories military spouses experience across deployment. We interviewed 50 Army and Army National Guard wives whose husbands served in missions to Iraq and Afghanistan. Participants graphed turning points and corresponding marital satisfaction levels across a recent deployment. Participants reported 519 turning points that fell into four supraordinate categories: Deployment/Military-Related Events, Life Events, Communication Events, and Other. Trajectories within each deployment phase reflected five patterns: Turbulent, Increasing, Decreasing, Stabilized, and Dipped. Most participants' trajectories reflected turbulence during the predeployment and deployment phases, and declining or dipped satisfaction during the postdeployment period. Results reflect varied experiences and provide useful information for those experiencing wartime separations or those supporting military families through deployment.

Reserve Component Costs: A Relook

Abstract: Army Force Generation (ARFORGEN) costing model suggests Active and Reserve forces cost about the same. Thus, many of the assumptions about the cost-effectiveness of Reserve Components may need a closer look. Budget Cycles we close the book on one of America's longest military engagements, the battle for shrinking resources is growing more intense. But what risk can we realistically assume before we place US security interests in jeopardy? Many solutions call for the Army to move more of its capabilities to the Reserve Component. However, the cost savings may not be as great as we might think. This article explores some of those costs through the Army Force Generation (ARFORGEN) costing model. Cost-Effective Reserve Components National Guard Bureau 2013 Posture Statement: Security America Can Afford states The National Guard is the DOD's most cost effective component. One of the reasons listed is that 11% of the Army Budget, the Army National Guard provides 32% of the Army's total personnel and 40% of its operating forces. (1) United States Army Reserve 2013 Posture Statement makes a similar claim: As the Army's only Federal Operational Reserve Force, the Army Reserve provides a cost-effective way to mitigate risk to national security. For only 6 percent of the Army budget, the Army Reserve provides almost 20 percent of the Total Force. (2) Clearly, the percentage of total force provided by each reserve component is correct. However, statements about percent of the Army budget need to be qualified. They hold true when viewing the Army budget purely from an appropriations-sponsor perspective, but the Army pays for several National Guard and Army Reserve expenses through active Army appropriations. Here are a few examples: * Other Procurement of Army (OPA) appropriation is used to purchase new equipment for all three components. Army may buy 50 new trucks and allocate ten to the ARNG and ten to the USAR. cost of new equipment is not included in reserve component appropriations. * Operations and Maintenance, Army (OMA) appropriation pays the overhead costs of operating ten rotations per year at the National Training Center (NTC) and Joint Readiness Training Center (JRTC). National Guard uses one rotation per year at each center and pays its own military personnel costs and a portion of the OM (2) establish common Army costing baselines to compare Active and Reserve Component costs; and (3) gain leadership agreement (AC, ARNG, and USAR) so those leaders could accurately engage the Office of the Secretary of Defense and other agencies outside the department. …

Validation of lay‐administered mental health assessments in a large Army National Guard cohort

To report the reliability and validity of key mental health assessments in an ongoing study of the Ohio Army National Guard (OHARNG). The 2616 OHARNG soldiers received hour-long structured telephone surveys including the post-traumatic stress disorder (PTSD) checklist (PCV-C) and Patient Health Questionnaire - 9 (PHQ-9). A subset (N = 500) participated in two hour clinical reappraisals, using the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM (SCID). The telephone survey assessment for PTSD and for any depressive disorder were both highly specific [92% (standard error, SE 0.01), 83% (SE 0.02)] with moderate sensitivity [54% (SE 0.09), 51% (SE 0.05)]. Other psychopathologies assessed included alcohol abuse [sensitivity 40%, (SE 0.04) and specificity 80% (SE 0.02)] and alcohol dependence [sensitivity, 60% (SE 0.05) and specificity 81% (SE 0.02)].The baseline prevalence estimates from the telephone study suggest alcohol abuse and dependence may be higher in this sample than the general population. Validity and reliability statistics suggest specific, but moderately sensitive instruments.

Long-Term Impacts of Controlled Burns on the Ant Community (Hymenoptera: Formicidae) of a Sandplain Forest in Vermont

Sandplain Pine-Oak-Heath forest is one of Vermont's most threatened natural communities due to fire suppression and land development. We studied the ant community in the largest remaining tract of sandplain forest in the state of Vermont, at the Camp Johnson Army National Guard Base, in Colchester. We investigated the long-term impacts of controlled burns conducted in 1995 and 1998 by examining ant specimens collected in burned and control (unburned) areas during September and early October of 2006, 2007, and 2008. The 1750 ant specimens from 911 pitfall traps yielded 29 ant species. Although sample effort was un-even, there was a greater than two-fold difference in species richness between the sites: 28 species in the burned site and 13 species in the control site. Ant abundance was significantly greater at the burned site compared to the control, and the Shannon index of species diversity differed as well. Canopy cover was significantly different in the burned site compared to the control site. Increased habitat diversity and increased forestfloor temperature following from the more open canopy in the burned area could potentially account for the greater abundance, species richness, and diversity of ants in the burned area. The striking differences in the ant communities of the burned versus the control areas 8–10 years post-burn demonstrate the potential usefulness of monitoring ants as indicators of the long-term ecological change induced by burning of the sandplain forest.

Jeffery M. Nelson, MD, FACS, FASCRS

Dr. Jeffery Nelson is a colon and rectal surgeon and chief of surgery at Walter Reed National Military Medical Center, Bethesda, MD. Jeffery was born in Ogden, UT, and received a bachelor of science in chemistry and a MD degree from the University of Utah in Salt Lake City, UT. He did his General Surgery Residency training at Tripler Army Medical Center in Hawaii. He then served for 2 years as a staff general surgeon at Landstuhl Regional Medical Center, Landstuhl, Germany. Following this service, Jeffery completed a Colon and Rectal Residency at the Northwest Colon and Rectal Clinic, Seattle, WA. Dr. Nelson then joined the staff at Walter Reed Army Medical Center in 2001, as chief of colon and rectal surgery and progressed to become chief of surgery. During his Army career, Jeffery spent multiple deployments as a staff surgeon in Iraq and other overseas locations. He has been promoted to the rank of colonel and he has been awarded several military decorations including three Meritorious Service Medals and the Bronze Star. Dr. Nelson is an associate professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda, MD, and is board certified in General and Colon and Rectal Surgery. He teaches military surgical residents and medical students on a daily basis and is an active participant in multiple surgical societies. His contributions to the medical literature include 13 peer-reviewed publications and he has made multiple presentations at national meetings. Jeffery, his wife, LTC Sarah J. Krajnik (who also serves in the Army National Guard), and his two children Ariana (8 years old) and Emily (5 years old) live in Laurel, MD. When not working, Jeffery is active in Crossfit (pretty much every day) and long-distance running. He also likes to read on American history and enjoys cooking. As a retired USAF surgeon, I can appreciate the dedication and sacrifices of the dedicated individuals in our armed services. We owe our freedoms and societal options to all of those who have served our country. Jeffery and several of his colleagues, who remain on active duty, have contributed to this issue. Their service and contributions merit our acknowledgment and gratitude. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I sincerely thank Dr. Nelson for serving as a guest editor and for providing us with a superb issue on Quality in Colon and Rectal Surgery.

Comfort, cliques, and clashes

One important but understudied source of support for Army families is the family readiness group (FRG). The current analysis of relationships with/in FRGs emerged from qualitative interviews conducted with 50 active-duty Army or Army National Guard wives whose husbands were deployed in support of Operation Iraqi Freedom or Operation Enduring Freedom between 2003 and 2005. Through our in-depth reflection and analysis of the transcripts, we recognized how these women’s lived experiences reflected complex relationships with/in their FRGs, which in some cases supported but in other cases marginalized spouses, thus constructing them as dilemmatic sites for their members. We identified two sets of contrasting constructions: FRGs as coping resources versus sources of stress and FRGs as confirming versus disconfirming environments. We conclude with practical advice for military communities and suggestions for future research.

EDiscovery implications, duties and consequences

Conference paper by Thomas M. Dunlap - the managing partner of Dunlap, Grubb & Weaver, PLLC. He is a graduate of Washington & Lee University School of Law (Phi Delta Phi), an avid pilot and serves as a Captain (Cavalry) in the Army National Guard (29th Infantry)and is currently the Commander of HHC, 116th BSTB Infantry.

Prospective Assessment of Health-Related Functioning Among Deployed U.S. Army Active Duty and National Guard Soldiers

This prospective study examined whether combat deployment differentially affected physical health–related functioning in U.S. Army National Guard (NG) versus Active Duty (AD) soldiers. Data collected in person at pre- and postdeployment assessments of 615 U.S. Army AD (n = 517) and NG (n = 98) male participants from infantry-type units deployed to the Iraq War were analyzed via linear mixed effects models. NG soldiers demonstrated significantly more adverse changes in physical health–related functioning than did AD soldiers. The adjusted Veterans RAND 12-Item Health Survey Physical Component Summary (PCS) score decreased 5% for NG versus 1% for AD from pre- to postdeployment. Adjustment for post-traumatic stress symptom severity did not alter these results.

Cost Effectiveness of Two Army Physical Fitness Programs

Repeated failure in the Army Physical Fitness Test (APFT) is associated with lower fitness level, premature discharge, and significant career disruption, at high economic and health costs to the individual soldier and the U.S. Army. We used cost-effectiveness analysis to estimate the health and economic implications of two exercise interventions for Army National Guard (ARNG) soldiers who had failed the APFT, a traditional remediation program and a new pedometer-based program called Fitness for Life, involving individual counseling and follow-up telephone calls. Effectiveness of the interventions was analyzed in terms of APFT pass rates and calculated 10-year coronary heart disease risk. Costs were calculated based on tracking of resources used in the programs. APFT pass rates were 54.3% and 47.9%, respectively, for traditional and Fitness for Life programs, p = not significant. Neither program affected 10-year coronary heart disease risk. For assumed APFT pass rates up to 40% without any formal remediation, both the traditional remediation program and the ARNG Fitness for Life intervention had cost savings without significant group differences. Depending on the ARNG unit and personnel preference, although the Fitness for Life Program was more expensive and thus less cost-effective, either program could be cost-effective and of benefit to the military.

In Memoriam: James Douglas

Captain James Douglas, U.S. Navy (USN), Retired, one of the original four faculty members of the Construction Engineering and Management graduate program at Stanford University, died on February 24, 2013, in San Rafael, California. In 1975, when the Construction Division of ASCE (the predecessor to the Construction Institute) celebrated the Division’s Golden Jubilee, Douglas authored a short paper, titled the “Past and Future of Construction Equipment–Part III.” In 1975, he also authored the book Construction Equipment Policy. His work and writings provided the foundation for all that followed in construction equipment economics. As a fellow in the ASCE, he was awarded the ASCE Thomas Fitch Rowland Prize in 1969 and the ASCE Construction Management Award in 1975. Douglas was born in Uvalde, Texas on October 1, 1914. He grew up in San Antonio, Texas and graduated from high school at the age of 16. As a youth, he earned the rank of Eagle Scout. Before he entered the United States Naval Academy at 20 years of age, he rode in a Calvary Regiment of the Texas Army National Guard (ARNG). He graduated from the Naval Academy with distinction and was commissioned in June 1938. The motto of the Navy Seabees, “Can Do,” summarizes his first career. In his early years, he served on board the USS Salt Lake City and the USS Wichita. In 1941, he married Sarah Maria “Sally” Bisset and continued his education at Rensselaer Polytechnic Institute, earning a Master of Civil Engineering degree in 1943. During WWII, he served in various Navy Seabee assignments, beginning with duty in the Aleutian Islands (Attu and Adak) and then the assault on Okinawa with the 87th Seabee Battalion. He was awarded the Bronze Star Medal with Combat “V” for heroic service during the campaign on Okinawa in World War II. His long naval career moved him around the globe with his family. Capt. Douglas commanded the construction of a major naval air base at Subic Bay, Philippines (the largest peacetime earth-moving job since the Panama Canal). Initially, the work was to be accomplished by civilian contractors, but the jungle at Cubi Point, the location of the 10,000-ft long runway into Subic Bay, and the Zambales Mountains discouraged their interest in the work, so the project was give to the Seabees in 1951. He was later Director of the Seabee Division in Washington, DC and from 1956–1959 was in charge of the construction of eight Seabee bases in the Antarctic (Operation Deep Freeze). He retired as Captain in August of 1961. Immediately after retirement from the Navy, he started a second career in academia at the age of 46 years. After two years at Stanford University, he received a Ph.D. in Civil Engineering and then accepted a faculty appointment. He taught and conducted research on construction equipment economics at Stanford University until he retired as an Emeritus Professor in 1980. He founded an executive education program for construction managers called “Stanford Sierra Construction College.” He was one of the first in the field of construction engineering to apply computer technology to complex engineering problems. He said, “I didn’t feel old until I was 95 years old.” Requiescat in pace.

Drug Positive Rates for the Army, Army Reserve, and Army National Guard From Fiscal Year 2001 through 2011

To examine the overall and drug-specific positive rates of Army urinalysis specimens tested from fiscal year 2001 (FY01) through FY11. We analyzed annual Army Forensic Toxicology Drug Testing Laboratory results from FY01 to FY11. From FY01 to FY11, the Army's positive rate was 1.06%. The component rates were 0.84%, 1.53%, and 1.94% for the active duty, Reserve, and National Guard, respectively. The Army's average positive rate for marijuana from FY01 to FY11 was 0.79%, and the cocaine rate was 0.26%. From FY06 to FY11, the average positive rate for oxycodone was 0.74% and the d-amphetamine rate was 0.30%. Apart from oxymorphone, a key metabolite of oxycodone, the positive rate for all other drugs tested was below 0.25%. The FY11 drug positive rates in decreasing order were oxymorphone > oxycodone > marijuana > d-amphetamine > codeine > cocaine > morphine > d-methamphetamine > methylenedioxymethamphetamine > heroin > methylenedioxyamphetamine > phencyclidine. Although the drug positive rate for heroin remains low, the number of positives has increased dramatically since FY05. The drug-testing program continues to serve as a vital deterrent as evidenced by the Army's overall positive rate being well below the 8.9% estimated illicit use in the civilian population.

Regionally Aligned Forces: Business Not as Usual

Abstract: Few understand the rationale or components of the Regionally Aligned Forces (RAF) concept. This article describes the concept and addresses its chief criticisms, namely, how it will account for diverse ground force requirements, how it relates to the Army's force structure, and its affordability. ********** The term Regionally Aligned Forces (RAF) is widely familiar today; however, few understand the basic elements of the concept, or the goals the Chief of Staff of the Army (CSA), General Raymond T. Odierno, wants to achieve with it. Officers in HQDA have been on the road communicating the RAF concept to as broad an audience as possible. But the concept has drawn its share of skeptics. The most common questions fall into three broad categories: 1) Regional alignment for what? What are the ground force requirements for today? What is the real demand? 2) Isn't this just a way for the Army to justify force structure? Is the Army really doing anything differently? 3) Is the RAF even affordable? Won't it collapse under its own weight due to our extraordinary fiscal challenges? This article addresses each of these broad questions and presents the basic concept and rationale for RAF. Why RAF? At its core, RAF is the CSA's initiative for aligning Army capabilities to an expanded set of requirements for the Joint Force--post-2014. As General Odierno stated at the Association of United States Army Eisenhower Dinner in October 2012, we will leverage the Army's mission command capability by organizing our missions around highly trained squads and platoons--the foundation for our company, battalion, and brigade combat teams--for specific mission sets and conditions. This regional alignment of forces will not only offer combatant commanders access to the full range of capabilities resident in the Army today, it will maximum flexibility and agility to national security decision-makers. (1) RAF is a critical first step in operationalizing the concept of Strategic Landpower, which is the combination of land, human, and cyber activities that make decisive outcomes more likely, and increases options for preventing and containing conflict. (2) RAF is integral to the Army vision of being Globally Responsive and Regionally Engaged and it is fundamental to our ability to Prevent, Shape and Win across the globe. It is essential to the US defense strategy and represents the Army's commitment to provide culturally attuned, scalable, mission-prepared capabilities in a changing strategic environment characterized by combinations of nontraditional and traditional threats. Army Regionally Aligned Forces are defined as 1) those units assigned to or allocated to combatant commands, and 2) those service-retained capabilities aligned with combatant commands and prepared by the Army for missions. They are drawn from the Total Force, which includes the Active Army, the Army National Guard, and the Army Reserve. They consist of organizations and capabilities that are: forward stationed; operating in a combatant command area of responsibility; supporting (or ready to support) combatant commands through reach-back capabilities from outside the area of responsibility. They conduct operational missions, bilateral and multilateral military exercises, and theater security cooperation activities. RAF specifically addresses those requirements that are enduring in nature for the combatant commander, from set-the-theater to the most-likely contingencies. Accomplishing such missions requires an understanding of the cultures, geography, languages, and militaries of the countries where RAF are most likely to be employed, as well as expertise in how to impart military knowledge and skills to others. Hence, much of the Army is and remains aligned by virtue of assignment or allocation to a combatant commander. In contrast, Global Response Forces (GRFs) are the designated Joint GRF that maintains a 24/7 global mission to deploy anywhere in the world within 18 hours, as well as the other service retained units that are required to stay intact and at a high states of readiness. …