Background Injury accounts for 30% of adolescent deaths in Guatemala; more than one-third are due to road traffic injuries (RTI). Little has been documented about adolescents who are most affected by RTI. This Photovoice project aimed to engage a cohort of rural Guatemalan adolescents to assess and voice perceived RTI risk factors and community strengths.

Methods The project enrolled 10 adolescents participating in a local Youth Leadership program. In-classroom group discussions were held with participants to identify RTI perceived risk and protective factors; adolescents then conducted Photovoice (photo-exploration) of their community’s injury risks/strengths.

Results RTI Risks: Five risk factors were identified during in-class discussion: desire for adrenaline, high speed travel, lack of traffic lights, distracted driving, and animals in streets. Adolescent photo-documentation identified an additional eleven risk factors: lack of separation between pedestrians and traffic, motorcycle-taxis, lack of curbs, steep drop-offs from the streets, narrow bridges, multiple passengers on motorcycles and in truck beds, young drivers, young children on motorcycles, broken glass and lack of helmets.

Community Strengths: Two community strengths were identified during classroom discussion: fences around homes and speed bumps. Photo-documentation resulted in identification of an additional six community strengths: guardrails, helmets, protective clothing, speedbumps in front of schools, school fences and security guards.

Conclusion RTI is a significant cause of adolescent mortality worldwide. Interactive injury prevention activities including Photovoice are important tools for motivating and involving this at-risk population to improve their understanding of injury risk and protective factors, which could result in increased safe behaviors.