Ciguatera poisoning (CP) is one of the most common non-infectious, seafood-borne illnesses in the Pacific Islands. It is caused by the consumption of seafood that has bioaccumulated ciguatoxins: potent neurotoxins produced by dinoflagellates of the genus Gambierdiscus. CP impacts the public health, socio-economic stability, and cultural practices across Oceania, where coastal communities depend heavily on marine resources. The most recent documented study of CP in American Samoa was in 1997, thus the current impacts on local fishing communities are unknown. This study aims to address this gap by examining local awareness, community experiences, and the prevalence of Gambierdiscus spp. Using a mixed-methods approach, surveys and interviews were conducted to explore pervasiveness and perceptions of CP, as well as its socio-cultural effects. Survey responses indicated limited awareness and underreporting of CP cases, but strong community interest in access to affordable test kits and educational resources. Interviews with experienced fishers revealed deep cultural connections to fishing, intergenerational knowledge of CP, and behavioral adaptations. Building on these findings, four fishing sites were selected for qualitative macroalgae sampling. The sampling approach successfully detected Gambierdiscus spp. in 24% of samples, while also identifying logistical challenges for future sampling efforts. This study offers essential insights for fishing communities and managers to understand the impacts and ways to mitigate the risk of CP in American Samoa.