Gunby et al. BMC Public Health 2012, 12:216 http://www.biomedcentral.com/1471-2458/12/216 give consent or stop what was happening; 2) using me sexually when I was asleep or unconscious from alcohol and when I came round (gained consciousness) I could not give consent or stop what was happening; 3) encouraging or pressurising me to drink alcohol until I was too intoxicated (drunk) to give consent or stop what was happening; and 4) using me sexually after I had been drinking alcohol and was conscious but too intoxicated (drunk) to give consent or stop what was happening. Participants were asked how many times they had experienced each of these four scenarios in relation to oral sex, vaginal penetration (by the penis, finger or other objects) and anal penetration (by the penis, fingers or other objects). An internal consistency reliability of 0.74 has been reported for the SES for female victims and test-retest agreement rates over a one week administration period were reported to be 93% consistent [32]. Since its development the SES has been revised in order to reflect changes in the law and the strategies used by perpetrators to procure sex. The most recent revisions occurred in 2006 during which time the questions became gender neutral [33]. Follow- ing discussions with the SES author the term ‘butt’ was substituted with ‘anus’ in order to make the questions relevant to a UK population. Responses from the SES questions were re-coded into a single dichotomous vari- able for whether or not the respondent had experienced alcohol-related non-consensual sex, be it oral, vaginal or anal since the age of 14. Drinking levels were measured using the Alcohol Use Disorder Identification Test (AUDIT), a tool developed by the World Health Organization to facilitate screening of excessive drinking [34]. AUDIT has a high internal consistency reliability of 0.84 [35] and high test-retest reliability [36]. The five item AUDIT has been recom- mended for use with student populations [37] and was therefore utilised here. Each item is scored zero to four giving a total of 20 and scores of five and above are taken as an indicator of hazardous drinking [37]. Other sections of the questionnaire included demo- graphic details and questions on: knowledge about the legal definition of consent; attitudes held by students on an individual’s capacity to consent to sex when alcohol had been consumed; attitudes towards the legality of scenarios depicting sex between intoxicated people; and attitudes towards alcohol-related sex, alcohol-related rape, false rape allegations and the role of alcohol in such circumstances. The questionnaire also described nine different actions or circumstances and participants were asked to indicate how relevant each cue was in helping to decide if the other person would agree to have sex with them. These cues were: 1) if the other person has been flirting with you during the evening; 2) if the other person has been kissing you during the Page 3 of 12 evening; 3) if the other person has voluntarily removed some of their clothing for you; 4) if the other person has voluntarily removed some of your clothing; 5) if the other person accepted a drink from you during the eve- ning; 6) if the other person verbally agrees to have sex with you; 7) if you’ve had sex with the other person pre- viously; 8) if the other person has a reputation for sleep- ing around; and 9) if the other person has agreed to go back to your house. All questions were gender neutral and devised follow- ing a review of the related literature. A pilot study was conducted with twelve students aged 18 to 24 years attending an East Midlands university and amendments were made accordingly. The research received approval from Liverpool John Moores University’s ethics committee. Univariate comparisons for male versus female, and those that had, versus those who had not, experienced alcohol-related non-consensual sex were conducted using chi square analyses because data were categorical. Backwards stepwise logistic regression models with sim- ple contrasts were used to examine multivariate associa- tions. Only records with complete data were included in multivariate analyses to ensure that likelihood ratio tests compared nested models. Analysis was conducted using SPSS v17 [38] and significance was set at P < 0.05 for all tests. Results The questionnaire data were investigated for erroneous and missing values. Of the 1,110 participants that com- pleted the questionnaire, 31 (2.8%) were removed because they did not state their age or that they were a student. Of the remaining 1,079 respondents, 817 (75.8%) were female, 259 (24.0%) were male and two (0.2%) identified themselves as transgender. The two transgender respondents were removed from subsequent analyses by sex because the sample size was too small to make this viable. The majority of respondents were white British (N = 902, 83.8%). Participants’ ages were as follows: 393 (36.4%) were aged 18 to 19 years, 451 (41.8%) were aged 20 to 21 years, 167 (15.5%) were aged 22 to 23 years and 68 (6.3%) were aged 24 years. Of the 1,072 people who responded to the SES questions, 329 (30.7%) had experienced alcohol-related non-consensual sex since the age of 14; this included 55 men and one person who was transgender. Bivariate analyses revealed a number of differences between men and women in relation to their knowledge and attitudes to alcohol and sexual activity (Table 1). A number of these differences persisted in the multivariate analysis (Table 2). When asked which cues were impor- tant when deciding if another person wanted to have sex with them, 59.1% of men and 45.0% of women felt