The report, which was based on data from the Environmental Protection Agency's Toxics Release Inventory, ranked the 20 worst states -- the so-called "Toxic 20" -- based on air pollution from power plants. Here's the list from worst to, well, less bad:
8. West Virginia
10. North Carolina
11. South Carolina
19. New Hampshire
According to the report by the private non-profit group, power plants are the single largest industrial source of toxic air pollution in 28 states and the District of Columbia. In Pennsylvania, airborne toxins from coal- and oil-burning plants account for 82 percent of the air pollution.
"Power plants are the biggest industrial toxic air polluters in our country, putting children and families at risk by dumping deadly and dangerous poisons into the air we breathe," Dan Lashof, director of the NRDC's Climate Center, said in a statement.
The report did not assess air pollution from non-industrial sources, which could explain why smoggy California didn't make the cut.
Metals emitted by power plants, such as nickel, cadmium and mercury, have been linked to respiratory illness, cancer and birth defects.
Dr. John Spangler, a professor of family medicine at Wake Forest Baptist Medical Center in Winston-Salem, N.C., said he has found an association between the level of nickel in the air and the rate of hospitalization for childhood asthma in counties throughout North Carolina. Spangler's ongoing research has also suggested a link between airborne cadmium and cancer of the colon, prostate and lung.
"It's hard to avoid the air you breathe," said Spangler. "What do you do, stay inside?"
Spangler said there was nothing surprising in the NRDC report, and hopes it could spark a change in policy on permitted plant emission levels.
"I think it is important for people to know that their state has high levels of toxins in the air, but if you have a coal-fired power plant in your vicinity there's not a lot you can do except move," he said. "It's hard for an adult to move out of a county. And for a child, it's impossible -- sort of like escaping secondhand smoke."
The EPA estimates that reducing pollution by levels proposed in the "Mercury and Air Toxics" standards, expected to be finalized in November, could save as many as 17,000 lives and prevent more than 12,000 hospital visits every year -- numbers Spangler said are on track.
"If you know that air pollution is associated with a disease as severe as hospitalization for asthma, then there should be an effort to decrease the amount of toxins in the air," he said. "And if the toxins in the air are related to coal power plants, we need to really rethink our coal policy."