Gunby et al. BMC Public Health 2012, 12:216 http://www.biomedcentral.com/1471-2458/12/216 In recent years there have been significant changes to the way that sexual offences are dealt with in jurisdic- tions across the western world. In England and Wales, advancements include the introduction of special mea- sures to assist victims to give evidence in court, improved practices and protocols for working with sur- vivors and an expansion of services to support victims [2]. Furthermore, a review of the law in relation to sex- ual offences culminated in the Sexual Offences Act (2003); legislation that dramatically altered the legal landscape relating to sexual offences generally and the offence of rape specifically. Despite these amendments concerns around the rape conviction rate remain [8-11]. Alleged sexual assaults are particularly difficult to prose- cute when the victim is voluntarily intoxicated by alco- hol at the time of the incident [2,12]. In the UK, alcohol consumption is a recognised risk factor for experiencing a sexual offence, and Police data indicate that in around half of rape cases the complai- nant had been drinking [13]. However, the contribution of alcohol in sexual offences is somewhat confused by societal views on the role alcohol plays in sexual situa- tions. Western society is permeated with positive images linking alcohol and sex [14], while research demon- strates that alcohol is often used, especially by young people, to facilitate sexual encounters and produce sex- ual effects [15,16]. As sex crimes often occur following social interactions involving alcohol consumption [17] it is realistic to surmise that non-consensual sex occurs, in certain cases, when consensual sex is also a potential outcome. Consequently, a person’s interpretation of the sexual situation may influence the potential for assaul- tive behaviour. Indeed, in order to mitigate possible rejection, the cues men and women use to signify attrac- tion are typically ambiguous [18]. This can easily lead to misinterpretation which is likely to be exacerbated when alcohol disrupts cognitive processes making it more dif- ficult to evaluate complex stimuli and situations [19]. Differences between men and women in relation to atti- tudes and knowledge of sexual situations are also likely to influence the outcome of such occurrences [20-24]. There is much evidence to show the association between alcohol use and non-consensual sex in Ameri- can student populations. In a recent study of 2,000 women, 6.4% reported that they had been the victim of a rape where drugs and/or alcohol had resulted in inca- pacitation [25]. In 96% of these cases alcohol was identi- fied as the substance used to procure sex and in the majority of instances alcohol had been consumed volun- tarily. There has been little research with students in England about their experiences of alcohol-related sex- ual assault which is perhaps surprising when alcohol consumption among this population is perceived to be high [26,27]. Page 2 of 12 The first aim of this study was to compare male and female students’ attitudes and knowledge about alcohol and sexual activity and their drinking behaviour. More specifically, we compared male and female students’ knowledge of the laws of consent; attitudes towards the cues they deemed important in deciding if another per- son would agree to have sex with them; attitudes towards the effects of alcohol on a person’s ability to consent to sex; attitudes about the impact of alcohol on the reporting of rape; and attitudes on the culpability or otherwise of women who are raped when they have been drinking alcohol. The second aim was to identify those factors that were associated with male and female students being the victim of alcohol-related non-consen- sual sex; again, a comparison was made in terms of their drinking behaviour and attitudes and knowledge about alcohol and sexual activity. Students aged 18 to 24 were included in the study because people aged 16 to 24 have the highest risk of experiencing non-consen- sual sex [28-30], while 18 represents the minimum legal age for purchasing alcohol in the United Kingdom. Methods One hundred and ten students aged 18 to 24 years were recruited to the study using non-probability sampling from a single university in the North West of England. These students completed an anonymous online ques- tionnaire from October 2008 to January 2009. Under- graduate and postgraduate students within four Faculties received an email invitation to participate in the questionnaire, available through a link embedded in the email. Posters detailing the study and inviting stu- dents to participate were also displayed in student areas of the university. This recruitment strategy meant that a small number of people outside of the university com- pleted the questionnaire; of these 22 were students at other universities who met the age criteria and their responses were included. The Sexual Experience Survey (SES), developed in the USA in the late 1970s, is the best available measure of non-consensual sexual experiences [31] and was used to identify alcohol-related non-consensual sex that occurred since the age of 14. The SES includes features that are widely recognised as standard approaches to the assessment of sexual victimisation. An example is the avoidance of the terms ‘rape’ and ‘sexual assault’ which participants frequently fail to respond to because they do not label their experiences as such, even if their experiences meet the legal definition for such offences. Instead the SES uses behaviourally specific descriptions of acts and tactics that mirror legal definitions of speci- fic sexual offences as follows: 1) serving me high alcohol content drinks when they appeared to be regular strength drinks until I was too intoxicated (drunk) to