The primary goal of this project was to evaluate how pre-weaned calf housing, environment and management strategies impact calf health during periods of cold stress. This was an observational study in which calf facilities were evaluated on a single visit conducted between November 29, 2016, and January 4, 2017. Housing included hutches (n = 8), individual pens in a barn (n = 8) and group pens in a barn (n = 11). Facility, calf pen and animal evaluations included: wind speed, temperature, relative humidity, heat stress index, wind chill, bedding type, ammonia concentration, nesting score, calf health scoring, and number of calves/pen. Data were analyzed using SAS 9.3 to determine the impact of housing type, environmental and management variables on calf health score. A total of 27 facilities and 426 pre-weaned calves were evaluated. The mean outdoor temperature was 6.3°C (SD = 5.6; range −5.2 to 19.4). Mean respiratory score was 2.8 (SD = 1.64; range 0 to 9) with 14.5% of calves evaluated scoring >5, indicating they have a respiratory challenge and should be treated. Prevalence of respiratory illness among calves ranged from 0 to 46% on a farm basis (mean = 15.0%), with 8 farms having no respiratory illness, and 6 farms having 30 to 46% of evaluated calves exhibiting signs of respiratory illness. Health score was affected (P < 0.05) by housing, bedding, number of calves per pen, NH₃ concentration, temperature and wind chill (at calf level). Calves housed in hutches had greater (worse) health scores as compared with those in group pens (3.9 vs 2.2, respectively).Calves in individual pens did not differ in health scores from their counterparts (mean health score = 3.3). Risk of health score >5 increased if calves had a body condition score <2 (relative risk = 1.7; 95% CI 1.0, 2.8), if ammonia concentration in the pen was >1 PPM (relative risk = 1.9; 95% CI 1.2, 3.0) and if calves/pen was >5 (relative risk = 1.6; 95% CI 1.0, 2.6). Data collected from this study suggests that respiratory illness continues to be a challenge. However, factors that increased the risk of respiratory illness can be addressed by changes in management practices.