For the first time, we documented regional differences in amounts and long-term trends of marine debris along the US Atlantic coast. The Southeast Atlantic had low land-based and general-source debris loads as well as no increases despite a 19% increase in coastal population. The Northeast (8% population increase) also had low land-based and general-source debris loads and no increases. The Mid-Atlantic (10% population increase) fared the worst, with heavy land-based and general-source debris loads that increased over time. Ocean-based debris did not change in the Northeast where the fishery is relatively stable; it declined over the Mid-Atlantic and Southeast and was correlated with declining regional fisheries. Drivers, including human population, land use status, fishing activity, and oceanic current systems, had complex relationships with debris loads at local and regional scales. Management challenges remain undeniably large but solid information from long-term programs is one key to addressing this pressing pollution issue. ?? 2010.