WASHINGTON - Deaths from lung cancer and other health problems tied to tobacco use are expected to double to 10 million per year by 2020 but the real figure likely will be much higher, researchers warned Friday.

A global survey of young people uncovered a surprising rise in tobacco consumption among girls and widespread exposure to secondhand smoke, according to an article published online Friday by leading medical journal The Lancet.

As a result, ''current dire warnings that the annual death toll will double to 10 million by 2020 may be a conservative estimate,'' said Charles Warren, the article's author.

''The true toll from tobacco use could be even greater with high rates of non-cigarette tobacco use and high rates of smoking among young girls,'' said Warren, a doctor in the U.S. Centers for Disease Control and Prevention's Office on Smoking and Health.

He urged ''a redoubling of efforts to prevent initiation and promote cessation among the large proportion of young people who currently use tobacco,'' and added that ''high exposure to secondhand smoke suggests a need for countries to pass strong and effective smoke-free policies.''

Warren led a team that surveyed some 750,000 students aged 13-15 years from 131 countries and the Gaza Strip and West Bank. The researchers said they found that nearly nine percent of students smoke and 11 percent use tobacco products other than cigarettes. These include chewing tobacco, pipes and water pipes, cigars, and cheroots.

The difference in current cigarette smoking between boys and girls is smaller than the difference between men and women, the team found. Earlier research had estimated that men were four times more likely than women to smoke. The latest survey found that among young people the likelihood was only 2.3 times higher. In many countries, researchers said they found no difference in smoking rates between boys and girls.

''Raised tobacco use by girls and narrow sex differences in tobacco use by adolescents is a recent and unexpected behavioral change in many parts of the world where tobacco prevalence in women is low compared with men,'' the researchers said.

Almost 20 percent of young people who had never smoked reported that they were susceptible to smoking in the next year, more than four in ten students said they were exposed to high levels of secondhand smoke at home, and five in ten said they had high exposure in public places.

The findings mean that mortality projections need to be raised and that public health strategies need to be retooled so they do not just target cigarette smoking, Warren and his colleagues said.

Survey data, they added, ''show high prevalence of tobacco use other than cigarettes by boys and girls across all world regions. Prevalence of other tobacco use is as high as or higher than cigarette prevalence in many regions of the world.''

In consequence, health campaigns aimed at fighting tobacco use must be retooled to also address tobacco products other than cigarettes, according to Warren.

''Overall tobacco use is a major public-health problem, and prevention programs must incorporate information about various tobacco products to be effective,'' he said.

India's experience suggests that existing efforts are missing their mark, The Lancet said in an editorial in this week's print edition.

''Findings published in this week's issue suggest that in India, which strengthened its laws against tobacco advertising in 2003 to bring it into line with the FCTC [Framework Convention on Tobacco Control] provisions, a new wave of tobacco use is taking hold among young people,'' the journal said.

It referred to a study by University of Minnesota researchers who surveyed 11,642 students in India and found that sixth-graders, aged 11 years on average, were two to four times more likely to use tobacco than were eighth-graders.

India is the world's second most populous country. Demographers expect its population to exceed China's in the next 25 years.

Health workers long have said that although tobacco use has been falling in wealthy ones as a result of tight regulation and efforts to educate the public about tobacco-related dangers, it has risen in poor countries.

''While projected 2020 tobacco-related deaths in developed regions are expected to rise 50 percent from 1990 levels, those in Asia will escalate almost four-fold,'' according to a recent assessment by the Global Health Council, an association of drug makers, non-profit groups, and international agencies.

The reasons for this include ineffective regulation and weak public education in poor countries, according to health advocates. Trade activists also have blamed multinational tobacco firms for aggressive marketing in poor countries and have accused wealthy governments of pressing poorer ones not to interfere with those firms' markets in the developing world.

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