Background In South America, road traffic injuries (RTI) are the leading cause of death of young adults. There is a disproportionate burden of vulnerable road users and road traffic fatalities and injuries, but little is known about related risk factor prevalence.

Methods We collected information on speeding, drink-driving, helmet, and seatbelt use, —all risk factors for RTI— in three Latin American cities: Bogota, Sao Paulo, and Fortaleza from 2015 to 2019. Univariate analysis was conducted to report summary measures for each city (frequencies and percentages) per round.

Results A total of 1,982,423 vehicles were observed for all risk factors in Bogota, Sao Paulo, and Fortaleza. Fortaleza had the highest increase in seatbelt and helmet use amongst all cities. However, the prevalence of seatbelt use in the back seat and child restraint use is low across cities. The speeding prevalence in Bogota and Fortaleza decreased, while in Sao Paulo it increased. Across cities, motorcycles were found to exceed the speed limit the most compared to other vehicles. The prevalence of drink-driving decreased across cities.

Conclusion Between 2015–2019, all three cities had significant improvements in road safety risk factors. However, targeted efforts should to reach at-risk populations (motorcyclists, children and back-seat passengers) in order to continue improving road safety.

Learning Outcomes It is key to characterize high-risk populations for RTIs. Injury prevention efforts should be focused on motorcycles (speeding and helmet use), seat-belt use in the back seat and child-seat use.