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Risky behaviours by pedestrians such as alcohol or drug use are understudied. This study aims to quantify the prevalence and characteristics of substance use among pedestrian fatalities in New York State, USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Fatality Analysis Reporting System was used to capture New York State pedestrian deaths from 2018 to 2020. Substance use was defined as the presence of alcohol, drugs, or both. Pedestrian death rates were calculated by age and sex. Statistical analyses used \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      , Fisher\u2019s exact test or t-test with significance defined as p&lt;0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 771 pedestrian deaths, 43.8% involved substance use. Drug-only involvement accounted for 18.3% of all deaths, which was slightly higher than alcohol-only involvement (13.7%) and alcohol and drug co-use (11.8%). Substance-involved deaths were more common among males than females and varied by circumstances such as time of day and pedestrian location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly half of pedestrian deaths in New York State involved substance use by the pedestrian. Public safety campaigns that traditionally emphasise drinking and driving should also address the dangers of walking while impaired. Interventions should encourage planning for safe travel and target high-risk groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-045980","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:15Z","timestamp":1783987215000},"page":"ip-2025-045980","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Substance use among fatally-injured pedestrians in New York State, USA: a retrospective analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2179-3235","authenticated-orcid":false,"given":"Jancarlos","family":"Guzman","sequence":"first","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F","family":"Garnett","sequence":"additional","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Pawlowski","sequence":"additional","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce C","family":"Pressley","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Health Policy and Management and the Columbia Center for Injury Science and Prevention, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah M","family":"Hines","sequence":"additional","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Hogan","sequence":"additional","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[{"name":"Bureau of Occupational Health and Injury Prevention, New York State Department of Health, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"2026071317000828000_ip-2025-045980v1.1","unstructured":"Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control . 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