Coastal rivers represent a significant pathway for the delivery of natural and anthropogenic sediment-associated chemical constituents to the Atlantic, Pacific and Gulf of Mexico coasts of the conterminous USA. This study entails an accounting segment using published average annual suspended sediment fluxes with published sediment-associated chemical constituent concentrations for (1) baseline, (2) land-use distributions, (3) population density, and (4) worldwide means to estimate concentrations/annual fluxes for trace/major elements and total phosphorus, total organic and inorganic carbon, total nitrogen, and sulphur, for 131 coastal river basins. In addition, it entails a sampling and subsequent chemical analysis segment that provides a level of ‘ground truth’ for the calculated values, as well as generating baselines for sediment-associated concentrations/fluxes against which future changes can be evaluated. Currently, between 260 and 270 Mt of suspended sediment are discharged annually from the conterminous USA; about 69% is discharged from Gulf rivers (n = 36), about 24% from Pacific rivers (n = 42), and about 7% from Atlantic rivers (n = 54). Elevated sediment-associated chemical concentrations relative to baseline levels occur in the reverse order of sediment discharges:Atlantic rivers (49%)>Pacific rivers (40%)>Gulf rivers (23%). Elevated trace element concentrations (e.g. Cu, Hg, Pb, Zn) frequently occur in association with present/former industrial areas and/or urban centres, particularly along the northeast Atlantic coast. Elevated carbon and nutrient concentrations occur along both the Atlantic and Gulf coasts but are dominated by rivers in the urban northeast and by southeastern and Gulf coast (Florida) ‘blackwater’ streams. Elevated Ca, Mg, K, and Na distributions tend to reflect local petrology, whereas elevated Ti, S, Fe, and Al concentrations are ubiquitous, possibly because they have substantial natural as well as anthropogenic sources. Almost all the elevated sediment-associated chemical concentrations found in conterminous US coastal rivers are lower than worldwide averages.