This study investigated whether occupational exposure in pulp and paper mills or geographic proximity to mills was associated with an increase in risk for respiratory disease hospitalizations. Three years (1980 to 1982) of 100% age- and sex-adjusted hospital admission rates for selected respiratory diagnoses were calculated for 66 Maine towns located between 0 and 15 miles for seven Kraft mills and four groundwood pulp and paper mills. Additional data collected for each town included the number of production workers at each mill, mill proximity, insurance coverage, hospital distance, bed size, fulltime equivalent physicians, unemployment and income rates. Regression results provide evidence that occupational exposure may be a significant factor in hospitalizations for respiratory infections, bronchitis and asthma, and respiratory signs and symptoms, although potential confounders (smoking, commercial health insurance) need to be examined.