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Indigenous people of the Torres Strait Islands have been concerned about the safety of their traditional seafoods since the discovery of high cadmium levels in the liver and kidney of dugong and turtle in 1996. This study explored links between urinary cadmium levels and consumption frequency of these traditional foods and piloted a community-based methodology to identify potential determinants of cadmium exposure and accumulation. Consultations led to selection of one community for study from which 60 women aged 30 to 50 years participated in health and food frequency survey, urine collection and a routine health check. Urinary cadmium levels were determined by inductively coupled plasma-mass spectrometry; data were analysed using SPSS-14. The geometric mean cadmium level in this group of women was 1.17 (arithmetic mean 1.86) μg/g creatinine with one-third exceeding 2.0 μg/g creatinine. Heavy smoking (≥300 pack years) was linked to higher cadmium in urine, as was increasing age and waist circumference. Analysis of age-adjusted residuals revealed significant associations (P<0.05) between cadmium level and higher consumption of turtle liver and kidney, locally gathered clams, peanuts, coconut, chocolate and potato chips. Dugong kidney consumption approached significance (P=0.06). Multiple regression revealed that 40% (adjusted r2) of variation in cadmium level was explained by the sum of these associated foods plus heavy smoking, age and waist circumference. No relationships between cadmium and pregnancy history were found. This paper presents a novel approach to explore contributions of foods and other factors to exposure to toxins at community level and the first direct evidence that frequent turtle (and possibly dugong) liver and kidney and wild clam consumption is linked to higher urinary cadmium levels among Torres Strait Islander women.Journal of Exposure Science and Environmental Epidemiology (2007) 17, 298–306. doi:10.1038/sj.jes.7500547; published online 24 January 2007 [ABSTRACT FROM AUTHOR]