The World Health Organization (WHO) attributes 4.9 million deaths annually to tobacco. That figure could reach 10 million by 2030. The Global Youth Tobacco Survey (GYTS), an international surveillance project developed jointly by WHO and the US Centers for Disease Control and Prevention (CDC), enables countries to monitor youth tobacco use and guide implementation and evaluation of tobacco prevention and control programs. The GYTS has been completed at 121 sites in 76 countries plus the Gaza Strip/West Bank, with national-level data generated in 52 countries, and city, state, or provincial/regional data generated in 24 countries. This paper reports on gender differences in tobacco use among young people in the six WHO Regions worldwide. Two unexpected findings emerged from the study. First, little difference existed between the genders in cigarette smoking or in use of other tobacco products. From 120 sites that collected data on cigarette smoking by boys and girls, more than one-half (n = 61) showed no difference by gender. For other tobacco products, 82 of 117 sites (70.1%) showed no difference by gender. Second, analysis revealed surprisingly high use of other tobacco products compared to cigarette smoking. Findings suggest programs should focus broadly on all tobacco products, not just cigarettes. Also, programs need gender-sensitive components that focus on unique consequences for females, such as effects on reproduction. Lack of gender differences in the study underscores the potential growth of the tobacco epidemic, especially among women in developing countries--where most sites in this study were located.