Peer E-Cigarette and Cannabis Use and Adolescent Anxiety: Findings from a Mixed-Methods Study

Objective: Adolescents are typically motivated to conform to peer influence, including substance use behaviors, and it is likely that adolescents who deviate from their peers' substance use behaviors might experience stress and anxiety.

Method: A mixed-methods approach was utilized to examine the relationship between peer e-cigarette and cannabis use and symptoms of generalized anxiety among a diverse sample of 12^th grade students in Los Angeles County, California, USA (N = 1,867, M_age = 17.04, SD = 0.43). Multivariable logistic regression models examined the associations between peer substance (e-cigarette and cannabis) use and anxiety. The interactions of prior e-cigarette and cannabis use on these relationships were also tested. Focus group data (n = 27) were analyzed to identify themes that could further inform the quantitative associations.

Results: Peer cannabis use was associated with increased odds of moderate - severe generalized anxiety (OR = 1.47, p = 0.02), but peer e-cigarette use was not (OR = 1.20, p = 0.28). These relationships were moderated by prior history of e-cigarette and cannabis use (OR = 0.44, p = 0.02; OR = 0.31, p = 0.001, respectively). Focus group findings highlighted exposure to friends and peers using substances and having mixed feelings surrounding peer use, including feelings of anxiety and discomfort with being around friends using substances or deviating from their friends' substance use behaviors.

Conclusion: These findings highlight the difficulties for teens navigating peer relationships and peer influence as their friends decide to participate in risky behaviors. Better health programs and interventions addressing peer influence, advocacy, and respecting one's decision to not use substances is needed.