Background: Omega-3 fatty acids from fish have been shown to have favorable effects on platelet aggregation, blood pressure, lipid profile, endothelial function, and ischemic stroke risk, but there are limited data on racial and geographic differences in fish consumption. Methods: Reasons for Geographic and Racial Differences in Stroke (REGARDS) is a national cohort study that recruited 30,239 participants age 45 years with oversampling from the southeastern Stroke Belt and Buckle and African Americans (AAs). Centralized phone interviewers obtained medical histories and in-home examiners measured weight and height. Dietary data for this cross-sectional analysis were collected using the self-administered Block98 Food Frequency Questionnaire (FFQ). Adequate intake of nonfried fish was defined as consumption of 2 servings per week based on American Heart Association guidelines. After excluding the top and bottom 1% of total energy intake and individuals who did not answer 85% or more of questions on the FFQ, the analysis included 21,675 participants. Results: Only 5,022 (23%) participants consumed 2 servings per week of nonfried fish. In multivariable analysis, factors associated with inadequate intake of nonfried fish included living in the Stroke Belt (vs non-Belt) (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.77-0.90) and living in the Stroke Buckle (vs non-Belt) (OR 0.89, 95% CI 0.81-0.98); factors associated with 2 servings per week of fried fish included being AA (vs white) (OR 3.59, 95% CI 3.19-4.04), living in the Stroke Belt (vs non-Belt) (OR 1.32, 95% CI 1.17-1.50), and living in the Stroke Buckle (vs non-Belt) (OR 1.17, 95% CI 1.00-1.36). Conclusions: Differential consumption of fish may contribute to the racial and geographic disparities in stroke. © 2011 by AAN Enterprises, Inc.