Background: Schools have the opportunity, through the National School Lunch Program and Local School Wellness Policies, to have a significant impact on healthy eating behaviors. An understanding of children's and adolescents' food preferences in relation to gender and age will facilitate the successful creation of both healthy and financially viable school menus. The purpose of this study was to identify food preferences with respect to gender of school-age children and adolescents in an Ohio school district. Methods: A survey was administered to 1818 3rd- to 12th-grade students in 1 rural northeast Ohio school district. Students filled out an anonymous questionnaire about their preferences for 80 different foods using a 5-point rating scale. The student data were grouped according to school level attended: elementary (3rd-6th), middle (7th-8th), and high school (9th-12th). An exploratory factor analysis identified entree and side dish factors. Cronbach's alpha was used to measure each factor's internal reliability. Differences in mean scores by gender and grade for each of the entree and side dish factors by gender and grade were identified using analysis of variance (ANOVA). Results: Boys preferred the meat, fish, and poultry foods over girls; girls preferred fruits and vegetables over boys (p less than 0.05). Furthermore, gender differences in preferences were also demonstrated with respect to school level. Conclusions: Food preferences differed between genders and these gender differences varied among elementary, middle, and high school students. Gender differences should be considered when providing food choices to boys and girls at all ages. (Contains 1 table and 5 figures.)