A 3-yr study was conducted to determine the degree of aggregation of stink bugs and boll injury in cotton, Gossypium hirsutum L., and their spatial association with a multispectral vegetation index (normalized difference vegetation index [NDVI]). Using the spatial analysis by distance indices analyses, stink bugs were less frequently aggregated (17% for adults and 4% for nymphs) than boll injury (36%). NDVI values were also significantly aggregated within fields in 19 of 48 analyses (40%), with the majority of significant indices occurring in July and August. Paired NDVI datasets from different sampling dates were frequently associated (86.5% for weekly intervals among datasets). Spatial distributions of both stink bugs and boll injury were less stable than for NDVI, with positive associations varying from 12.5 to 25% for adult stink bugs for weekly intervals, depending on species. Spatial distributions of boll injury from stink bug feeding were more stable than stink bugs, with 46% positive associations among paired datasets with weekly intervals. NDVI values were positively associated with boll injury from stink bug feeding in 11 out of 22 analyses, with no significant negative associations. This indicates that NDVI has potential as a component of site-specific management. Future work should continue to examine the value of remote sensing for insect management in cotton, with an aim to develop tools such as risk assessment maps that will help growers to reduce insecticide inputs.