AbstractRoad traffic accidents (RTAs) in Pacific societies in general are examined and a case study presented. There is a paucity of data on Pacific RTAs. Available data are generally poor in quality and specificity, with few adequate measures of risk. Despite this, it is clear that motor vehicle accidents are responsible for considerable mortality and morbidity throughout the Pacific. Most Pacific societies are in a state of low motorization and are experiencing high vehicle fatality rates but low population fatality rates. When motorization reaches a higher level, however, RTA deaths and injuries begin to have an impact on population structure and on societal as well as family economies. Using archival and ethnographic evidence, examination is made of the sociocultural context of motor vehicle use, roaduser behavior, and RTA occurrence on Niue Island, a nation with a high degree of motorization. Motorcycles are the preferred mode of transport on Niue. Cultural values and behaviors that affect motor vehicle accident rates include exaggerated risk‐taking, especially by young adult males. Alcohol plays a significant role in driving and other risky behaviors. Such behavior appears not just on Niue but in other Pacific nations also. It is vital to effectively monitor motor vehicle collisions and the effects of road and traffic development in these small scale societies. Culturally appropriate “road rules” and driver education campaigns, enforcement of traffic ordinances, highway improvement, and the development of safe public transport systems will be needed in order to reduce both short‐term and long‐term consequences of continued motorization and RTAs. © 1993 Wiley