Transporting passengers in the cargo area of pickup trucks is a public health safety issue in the United States. Our study compared crashes involving passengers in the cargo area with those involving passengers in the cab. We obtained data for all injury events of pickup occupants for 1990 from the California Highway Patrol. A total of 702 traffic reports coded as having passengers riding in pickup truck beds involved 1,685 passengers in the cargo area and 865 in the cab. Significantly more events involving passengers in the cargo area occurred in summer in rural areas and were noncollisions than did events with only cab passengers. Crashes with passengers in the cargo area resulted in death in 5% of passengers. Of the drivers, 81% were male and 22% were younger than 20 years. Among the 1,685 passengers in the cargo area, 65% were male, 36% were younger than 15 years, and 30% were ages 15 to 19 years. Passengers in the cargo area were more frequently ejected and more seriously injured than their counterparts in the cab. Legislation to restrict travel in truck beds and the design of restraints for this area are some measures that may reduce the risk of injury.