Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Epidemiology (Medicine)

Date of Defense


First Committee Member

Lora E. Fleming

Second Committee Member

James D. Wilkinson

Third Committee Member

Shari Messinger-Cayetano

Fourth Committee Member

David J. Lee


The mortality rate for elderly pedestrians struck by vehicles is the highest of any age group, approaching 30% in several large series. Currently, there is a lack of epidemiological studies of the risk factors associated with elderly pedestrian injury; in particular, few prospective studies of elderly pedestrian injuries have been performed. The primary purpose of this project was to identify risk factors that will lead to the development and implementation of effective prevention strategies to reduce the risk of pedestrian injury in this vulnerable population. The project had three phases. In phase 1, pilot studies were performed and identified potential risk factors for elderly pedestrians and confirmed their ability to recall accident details. Risk factors identified included certain walking and street crossing behaviors, as well as the lack of use of assistive devices. In Phase 2, the relatively new case-crossover design was utilized to investigate the association of transient (proximate) triggers or exposures with elderly pedestrian injuries. The relative risk of injury if not obeying the traffic signal is five-fold (odds ratio = 5.2; 95% confidence interval = 1.8 – 15.1). Risk factors such as use of sedating or mood altering medications, or the use of alcohol did not have sufficient discordance for analysis. The behavioral findings suggested that educational programs and behavioral modification might play an important role in designing future interventions. Therefore, in Phase 3, an elderly pedestrian safety program called Safe Crossings was created and evaluated. Over 700 subjects participated in the programs, with 99% reporting they felt it was an important topic and 93% acknowledging they learned something from the program. Focus groups were also utilized to help refine the content and delivery of the program. Posters and brochures were created and distributed in English, Spanish and Creole. The program is now set for wider dissemination and validation.


elderly; pedestrian; injury; case-crossover; risk factors; prevention