Background: Smoking behavior and smoking cessation are complex. Interpersonal factors such as childhood adversity are associated with smoking, especially in women. Identifying how and in whom these individual factors contribute to smoking behavior may support individualized smoking cessation strategies. Attachment insecurity (attachment avoidance and attachment anxiety) involves biological and psychological processes in close relationships and is associated with both childhood adversity, and in select populations, smoking. This study aims to identify an association between attachment insecurity and smoking in adults and to determine if attachment insecurity is a plausible mediator between childhood adversity and smoking.Methods: In a cross-sectional survey, 348 primary care patients reported childhood adversity, attachment insecurity and smoking status. Statistical analyses were performed using regression and PRODCLIN.Results: Sixty-one percent of participants had experienced childhood adversity and 20% were current smokers. In women, attachment anxiety was associated with both childhood adversity (p=.002) and current smoking (p=.04). The PRODCLIN test indicated that attachment anxiety may be a mediator between childhood adversity and current smoking in women (95%CI 0.003, 0.236). In men, current smoking was not associated with childhood adversity (p=.673) or attachment anxiety (p=.29). Attachment avoidance was not related to current smoking in men (p=.31) or in women (p=.16).Conclusions: In women but not in men, attachment anxiety is associated with current smoking and may mediate the relationship between childhood adversity and current smoking. Childhood adversity and attachment anxiety may be factors to consider in the design of cessation strategies for women.