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Promoters of child and adolescent health are taking to the soccer field to get young players thinking about how to live a safer and healthier life.

Two teams square off on a soccer field. The players are all between 8 and 12 years old, but when they kick the ball, they look like miniature Pelés or Lalas. Then one of them falls after being tripped by an opposing player. Within seconds, little fists are flying. The coach halts the game, gathers the kids around him, and sits down with them on the grass. For the next few minutes, he talks with them about violence: Why do they feel so angry? Why do they want to hit someone? What are some ways of resolving a conflict without resorting to fistfights?

Without realizing it, the young soccer players have learned a valuable lesson in public health.

Scenes like this are the essence of a program that promotes health among boys in Latin America's ever-popular "soccer schools." The objective is to help the children grow into men whose idea of masculinity is not a threat to themselves or their partners.

Matilde Maddaleno, an expert in adolescent health at the Pan American Health Organization (PAHO), cites data from a 2002 study of nine countries in Latin America. "We found that machismo is still monolithic and that being a ‘real man' is seen as more important than being healthy. But at the same time, there are fissures—behaviors that tend toward gender equity—through which we can break those parameters."

Toward that end, Maddaleno and her team launched "Soccer Schools: Playing for Health," a program that trains soccer coaches in low-income neighborhoods to promote health on the playing field.

"The coach is a powerful figure for boys, someone they really respect," says Maddaleno. "That makes him the ideal person to be promoting health."

By late 2004, Maddaleno's program was at work in six countries: Argentina, Brazil, Chile, Mexico, Paraguay, and Venezuela, with more than 200 coaches attending workshops to learn how to take public health messages to the 1,023 preadolescents and adolescents under their tutelage.

By the end of this year, Maddaleno plans to complete an evaluation of the impact of the program. "Once we demonstrate the program's efficacy, we'll be able to expand it to other sports and design a similar program for girls," she says.

Much of the PAHO initiative is based on a study by Rodrigo Aguirre and Pedro Guell titled "Becoming Men: The Construction of Masculinity in Adolescence and Its Risks." The study argues that "the cultural forms that masculinity takes have negative consequences for public health. Problematic behaviors in the area of health, such as violence, risk of HIV infection, addiction, or early paternity, are related to masculinity."

In Latin America and the Caribbean, the burden of illness for men is 26 percent higher than for women. The social construction of masculinity plays a role in many high-risk behaviors associated with the major sources of this morbidity, including traffic accidents, homicides, unprotected sex, and alcohol-related injuries. The soccer field is one of the key venues where masculine identity is passed from one generation to the next, and experts see it as an excellent place to introduce public health messages.

Not every coach is health-promotion material. "We offered training to coaches with a particular profile, those who consider themselves educators and who have an interest in acquiring new tools and in exploring health topics," says Francisco Aguayo, a clinical psychologist who participated in the project's first stage. "We had some very positive experiences, for example in Asunción and São Paulo, where psychologists and teachers participated in training sessions. They saw these ideas at work in real-life situations with coaches and players."

As part of their training, the coaches receive a kind of operator's manual to guide their work. After the average four-day training period, most say the experience strengthens their abilities to create a climate of acceptance, to present subjects in a compelling way, and to use more participatory methods that foster better communication among children on their teams.

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