Sediment is one of the leading pollutants in rivers and streams across the United States (US) and the world. Between 1992 and 2012, concentrations of annual mean suspended sediment decreased at over half of the 137 stream sites assessed across the contiguous US. Increases occurred at less than 25 % of the sites, and the direction of change was uncertain at the remaining 25 %. Sediment trends were characterized using the Weighted Regressions on Time, Discharge, and Season (WRTDS) model, and decreases in sediment ranged from −95 % to −8.5 % of the 1992 concentration. To explore potential drivers of these changes, the sediment trends were (1) parsed into two broad contributors of change, changes in land management versus changes in the streamflow regime, and (2) grouped by land use of the watershed and correlated to concurrent changes in land use or land cover (land use/cover), hydrology and climate variables and static/long-term watershed characteristics. At 83 % of the sites, changes in land management (captured by changes in the concentration–streamflow relationship over time; C–Q relationship) contributed more to the change in the sediment trend than changes in the streamflow regime alone (i.e., any systematic change in the magnitude, frequency or timing of flows). However, at >50 % of the sites, changes in the streamflow regime contributed at least a 5 % change in sediment, and at 11 sites changes in the streamflow regime contributed over half the change in sediment, indicating that at many sites changes in streamflow were not the main driver of changes in sediment but were often an important supporting factor. Correlations between sediment trends and concurrent changes in land use/cover, hydrology and climate were often stronger at sites draining watersheds with more homogenous, human-related land uses (i.e., agricultural and urban lands) compared to mixed-use or undeveloped lands. At many sites, decreases in sediment occurred despite small-to-moderate increases in the amount of urban or agricultural land in the watershed, suggesting conservation efforts and best-management practices (BMPs) used to reduce sediment runoff to streams may be successful, up to a point, as lands are converted to urban and agricultural uses.