To define mechanisms of susceptibility for populations affected by environmental exposures, both exposure and toxicity assessments must be considered. This review examines cultural and lifestyle factors that help define potentially susceptible populations in two groups, Asian and Pacific Islanders (API) and members of Tribal Nations in the Pacific Northwest region of the US and Western Canada. These groups, which may consume 10 times more fish and seafood than average US consumers, have special dietary practices that can lead to significant exposures to persistent pollutants and biotoxins found in fish and shellfish. The mechanism of toxicity of these contaminants is also important. Using the example of dioxin-like polychlorinated biphenyls (PCBs), different risk assessment approaches are presented and the analytical sensitivity needed to assess risk for different consumption groups is evaluated quantitatively. Our studies have also shown that regulatory agencies evaluation of fish consumption for average US populations do not always adequately consider unique consumption and cooking practices of these groups. Partnering with communities is important for appropriate exposure and risk assessments. This also empowers proactive action by communities to evaluate the risks and many benefits of fish and shellfish consumption and develop risk management strategies tailored for their communities.