Objective: To examine mother-child dietary concordance that may contribute to healthy eating practices critical to cancer prevention in underserved rural families. Methods: A brief food frequency questionnaire was administered to 404 sixth-graders and their mothers in rural Virginia and New York. Results: Significant dietary fat concordance rates were indicated for mother-daughter dyads only. A 3-way interaction revealed that African American girls with mothers who report high fat intake are at highest risk for health-compromising dietary behaviors. Conclusion: Interventions may need to differentially motivate male and female adolescents and incorporate familial and cultural influences to promote healthy eating in rural youth.