Objective. Using nationally representative data, this study examined the prevalence of very frequent physical fighting (≥12 times per year) among youth in 27 countries and cities. Frequent physical fighting has rarely been reported in the previous literature despite the implications for research and practice. Methods. Analyses were based on theGlobal School-based StudentHealth Survey (2003–2008) and the 2009 US Youth Risk Behavior Survey. Multinomial regression analyses were conducted to determine gender differences in frequent fighting. Countrieswere categorized into five regions (Sub-Saharan Africa, Central and South America,Asia, Eastern Mediterranean, and the United States), and one-way ANOVA tests were used to determine regional differences. Results. The prevalence of frequent fighting was highest in Zambia (7.7%) and lowest inMyanmar (0.5%). Gender differences were found in 20 countries, with boys beingmore likely to report frequent fighting than girls. The prevalence of frequent fighting varied by region (𝐹(3, 22) = 4.78, 𝑃 = .01), with the Eastern Mediterranean having a significantly higher prevalence of frequent fighting than Asia (𝑃 < .01). Conclusion.The prevalence of frequent fighting varies by gender in many countries and varies across world regions.More cross-national research is needed to better understand the sociocultural context of frequent fighting and to inform youth violence prevention efforts.