The three Midwestern cities tie for year-round particulate pollution, thanks largely to industry and the burning of coal, which provides the bulk of electricity in the region. Cincinnati is improving, however—the number of days with high ozone levels fell by ore than half between 1996-1998 and 2009-2011.
The 10 Most Polluted Cities in America
Bakersfield, Merced and Fresno top the American Lung Association's list of cities with the most persistant air pollution in the country in 2013
#10: Cincinnati, OH-Middletown, KY-Wilmington, IN
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10 U.S. Cities With The Dirtiest Air