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Purpose. We studied pedestrian traffic injuries among middle school adolescents in rural China, focusing on the effects of sleep problems and school-related stress. Methods. Using a modified Children’s Sleep Habits Questionnaire, we surveyed 1,551 middle school students in Hunan Province to investigate their sleep patterns, school habits, and pedestrian traffic injuries during a three month recall period. Results. There were 56 cases of pedestrian traffic injury reported among the surveyed students yielding a rate of 3.6 % over the three month period. The greatest proportion of the incidents involved a motorcycle (80%), followed by tractors (12%) and cars or buses (8%). The activity of the student at the time of the injury was evenly split between walking and riding a bicycle. Nearly two fifths of injuries resulted in a period of activity restriction lasting one day or more (39%). The amount of time spent traveling to and from school was not significantly related to risk of pedestrian injury. School performance was also not a significant risk factor; however, academic stress from parents was associated with pedestrian injury (P<.001). Sleep disturbances measured in difficulty falling asleep on school days was also significantly higher in children who experienced pedestrian injury (P<.05). These trends were not observed in multivariate analysis after adjusting for possible confounding variables. Conclusions. School-related stress and sleep patterns were identified as possible risk factors in this population for pedestrian injury. Further research is warranted in order to study these factors and develop prevention strategies to address these preventable injuries. Jaung