Every year in the United States automobiles kill about 6,000 pedestrians and injure another 70,000, a significant health burden, especially for cities where pedestrian deaths and injuries are most common. Over 35% of all fatally struck pedestrians are under the influence of alcohol at the time they are killed. Many cities are developing and promoting nightlife districts, prominently featuring alcohol-serving establishments, as part of economic development plans to revitalize urban spaces. By clustering alcohol outlets, these urban initiatives may also cluster intoxicated pedestrians near intoxicated or distracted drivers. Currently, research and public policies focused on preventing pedestrian fatalities fail to account for the built environments pedestrians walk into when they leave alcohol-serving establishments, despite the risks these environments pose for pedestrian injuries and fatalities. In addition, emerging evidence suggests that homeless individuals are at particular risk for pedestrian injury, and they make up a significant percentage (~25%) of the pedestrians killed while under the influence of alcohol. Cities across the U.S. are developing plans to prevent all pedestrian fatalities, yet none of these city plans even mention the role of alcohol use by pedestrians or have action items to address this modifiable risk factor. The broad objective of this proposal is to conduct a nationwide geographic case-control study of pedestrian fatalities to identify modifiable retail, built, economic and social environment risk factors within cities, especially risk factors related to alcohol sales and consumption. Case locations will be urban street segments or intersections where pedestrians were fatally struck from 2017-2018 and two control locations, street segments or intersections where fatalities did not occur, will be matched to the case locations. The presence of alcohol retail establishments (e.g. bars, clubs, liquor stores), nightlife districts, services for the homeless and encampments and informal sheltering locations (e.g. bridges and overpasses) will serve as the key independent variables of interest. We hypothesize that alcohol-involved pedestrian fatalities are a distinct subtype of pedestrian fatality and have different built environment risk factor profiles from pedestrian fatalities that do not involve alcohol. Neighborhood-, street- and intersection-level features for case and control locations will be measured via GIS analyses and via neighborhood audits conducted using Google Street View and our online research tool, the Computer Assisted Neighborhood Visual Assessment System (CANVAS). As part of this proposal we will expand the capabilities of CANVAS for conducting nationwide virtual neighborhood audits via Google Street View. We will also test whether proximity to retail alcohol outlets, nightlife districts or services for the homeless increases risk for pedestrian fatality and whether this risk is heightened by built environments that: encourage pedestrian activity; place pedestrians near road traffic; or cause distractions to pedestrians or drivers. This project will be highly innovative as the first national study to identify modifiable environmental characteristics related to alcohol as potential solutions to reduce pedestrian injury risk within cities.

Project Narrative In the U.S. approximately 70,000 pedestrian injuries and over 6,000 deaths occur annually and pedestrians are commonly under the influence of alcohol when they are injured or killed; approximately 40% of fatally struck pedestrians are under the influence of alcohol at the time they were killed. Current urban planning and design trends and initiatives in the U.S. are likely to place more pedestrians at risk of injury and fatality, particularly pedestrians who are under the influence of alcohol, and current Federal and municipal plans to reduce pedestrian injuries provide no provisions for pedestrians who are under the influence of alcohol. We propose to build web- based geospatial tools to support research on alcohol and pedestrian injury and to conduct a national location- based case-control study of pedestrian fatalities, to answer the questions of whether proximity to retail alcohol outlets, nightlife districts and services for the homeless increase the risk of pedestrian fatality and whether this risk is heightened by built environment features that encourage pedestrian activity, place pedestrians near road traffic and cause distractions.