Pedestrian education is a popular approach, but with the exception of children, there is a lack of evidence regarding the effectiveness of safety education. Modification of car fronts and other vehicle features to reduce the severity of injuries to pedestrians is a focus in Europe, where approximately 20% of all fatalities among road users involve pedestrians and cyclists 8 however, this approach has not been a priority in the United States despite research showing potential benefits. In terms of constructing a framework for prevention of pedestrian injuries, primary approaches include modification of the built environment, enforcement of traffic safety laws, motor vehicle design changes, and pedestrian education. 3, 4 The prevalence of alcohol use among injured pedestrians is well documented. 1 Pedestrians older than 65 years are more likely than younger pedestrians to be struck at intersections. 3 Children aged 5 to 9 years have the highest population-based injury rate, and people older than 80 years have the highest population-based fatality rate.

1, 2 Pedestrians account for 11% of all motor vehicle deaths, and in cities with populations exceeding 1 million, they account for about 35%. It is estimated that, each year, 80 000 to 120 000 pedestrians are injured and 4600 to 4900 die in motor vehicle crashes in the United States. DESPITE DECLINING RATES OF pedestrian fatalities (most notably declines among children and older adults), pedestrian crash injuries remain a serious public health problem.

Crosswalks are often marked with