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 RESULTS: Peer cannabis use was associated with increased odds of moderate - severe generalized anxiety (OR = 1.47, 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.