They are primarily produced in India and in some Southeast Asian countries, and are imported into the United States.
Research shows that bidis are a significant health hazard to users.
Bidis are not a safe alternative to cigarettes. One study found that one bidi produces more than three times the amount of carbon monoxide and nicotine and more than five times the amount of tar than one cigarette, when tested on a standard smoking machine. The Federal Trade Commission requires that packs of bidis display the Surgeon General's rotating health warning labels. Bidi smokers have an increased risk of coronary heart disease and cancers of the mouth, pharynx and larynx, lung, esophagus, stomach, and liver. Bidi use during pregnancy can cause perinatal mortality.