Introduction Road traffic accidents (RTAs) are the leading cause of death, especially in the young age category. Pakistan is a populous country with a huge number of vehicles on the roads with few safety and security measures.

Objectives To determine the prevalence of high-risk behaviours, road crashes and the factors contributing to road crashes among commercial drivers.

Materials and Methods A cross-sectional study on commercial drivers was conducted at the largest government bus/truck station in Peshawar, Pakistan. Data regarding socio-demographic characteristics and high-risk behaviours were collected from 400 commercial drivers through a structured questionnaire. Results: The mean age of the drivers was 38±7.7years. More than half (54%) of the drivers were unable to read traffic signboards. Around one third (31%) of the commercial drivers had road traffic accidents in the past. Regarding high-risk behaviour; around one fifth (19%) of the drivers reported overspending, two-thirds (66%) used a cellphone while driving, (39.5%) of drivers use cannabis while driving. Multiple logistic regression analysis showed that over speeding (OR= 3.8, 95% CI 2.58 — 5.64, P = 0.001), running red lights (OR = 2.2, 95% CI 1.19 — 4.06, P = 0.01) and poor vision (OR = 2.59, 95% CI 1.23—5.46, P = 0.012) were associated with RTAs.

Conclusion High-risk behaviours like overspeeding, running red lights, and poor vision was found to be strongly associated with road traffic accidents. Strict checks and balances from the traffic police are needed to overcome these high-risk behaviours.