Cigarette smoking after bariatric surgery is associated with complications and is advised against in clinical guidelines. However, it continues to be problematic and there is a paucity of research regarding the factors related to smoking in this population. This secondary data analysis study uses previously collected longitudinal data and moderated mediation analysis to determine if emotion regulation (Difficulties in Emotion Regulation Scale) mediates the relationship between adult attachment style (Experiences in Close Relationships scale) and the likelihood of smoking postsurgery. Psychopathology (diagnoses and symptom measures [Patient Health Questionnaire-9; Generalized Anxiety Disorder-7]) was considered as a moderator. A total of 423 adult patients at the Toronto Western Hospital Bariatric Surgery Program participated. Attachment insecurity predicted emotion dysregulation, which predicted likelihood of smoking. Anxiety scores moderated the mediating effect, such that protective effects were observed for low to average anxiety. Implications for targeting emotion dysregulation and anxiety to reduce smoking are discussed. Keywords: bariatric surgery, smoking, tobacco, adult attachment style, emotion regulation, psychopathology, depression, anxiety, moderated mediation

Cigarette smoking after bariatric surgery is associated with complications and is advised against in clinical guidelines. However, it continues to be problematic and there is a paucity of research regarding the factors related to smoking in this population. This secondary data analysis study uses previously collected longitudinal data and moderated mediation analysis to determine if emotion regulation (Difficulties in Emotion Regulation Scale) mediates the relationship between adult attachment style (Experiences in Close Relationships scale) and the likelihood of smoking postsurgery. Psychopathology (diagnoses and symptom measures [Patient Health Questionnaire-9; Generalized Anxiety Disorder-7]) was considered as a moderator. A total of 423 adult patients at the Toronto Western Hospital Bariatric Surgery Program participated. Attachment insecurity predicted emotion dysregulation, which predicted likelihood of smoking. Anxiety scores moderated the mediating effect, such that protective effects were observed for low to average anxiety. Implications for targeting emotion dysregulation and anxiety to reduce smoking are discussed. Keywords: bariatric surgery, smoking, tobacco, adult attachment style, emotion regulation, psychopathology, depression, anxiety, moderated mediation