This article provides a review and critical synthesis of research related to public health concerns for neighbors exposed to emissions from large-scale swine production operations. The rapid industrialization of pork production in the 1990s produced a generation of confined animal feeding operations (CAFOs) of a size previously unseen in the U.S. Recent research and results from federally sponsored scientific symposia consistently indicate that neighbors of large-scale swine CAFOs can experience health problems at significantly higher rates than controlled comparison populations. Symptoms experienced by swine CAFO neighbors are generally oriented toward irritation of the respiratory tract and are consistent with the types of symptoms among interior confinement workers thathave been well documented in the occupational health literature. However, additional exposure assessment research is required to elucidate the relationship of reported symptoms among swine CAFO neighbors and CAFO emissions.