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Importance: A key assumption of occupational therapy is that engagement in meaningful activities is fundamental to one's health and well-being. Preliminary findings suggest a link between childhood adversity and engagement in meaningful activity. Childhood adversity is also linked to attachment insecurity in adulthood, and both represent barriers to health and well-being. It is unknown whether attachment insecurity is associated with meaningful activity engagement or how attachment insecurity influences the relationship between childhood adversity and meaningful activity engagement., Objective: To investigate the association between attachment insecurity and meaningful activity engagement and the role of attachment insecurity in the relationship between childhood adversity and engagement in meaningful activities in adulthood., Design: Cross-sectional online survey., Setting: Community., Participants: Community-dwelling adults ages 18 yr or older, healthy, and able to understand standard English to complete the questionnaires. Participants were recruited through snowball sampling., Outcomes and Measures: Participants answered demographic questions and completed three questionnaires: the Engagement in Meaningful Activities Survey, Risky Families Questionnaire, and Experiences in Close Relationships-Short Form., Results: Participants (N = 329) completed at least two of the three surveys, with most (n = 312) completing all three. More insecurely attached participants reported less engagement in meaningful activities. Both attachment avoidance and attachment anxiety mediated the relationship between childhood adversity and meaningful activity engagement., Conclusions and Relevance: The findings offer support for interrelations among childhood adversity, attachment insecurity, and engagement in meaningful activity. Further research is required to support the application of these findings in clinical settings. Plain-Language Summary: To our knowledge, this is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood. The findings highlight the heightened vulnerability of adults who have a history of childhood adversity. The findings also emphasize the significance of (1) considering clients' childhood adversity and attachment patterns when assessing for and providing occupational therapy services and (2) advocating for the inclusion of trauma-informed practices for those with lower levels of meaningful occupational engagement., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)