Abstract
One in five women experience sexual victimization in her lifetime, making sexual victimization a significant public health crisis. This public health crisis also has detrimental health consequences. Understanding the scope of sexual violence and the effects of prevention programming requires accuracy in measuring sexual violence. Yet, a wealth of research suggests lack of precision in sexual violence measurement and potential confusion among respondents in how to interpret items on sexual victimization and perpetration questionnaires. Specifically, alcohol-involved sexual violence questions are among the hardest to operationalize in such questionnaires, due, in part to cultural ideas about alcohol and idiosyncratic effects of alcohol on behavior. The current study addressed this gap by assessing the construct validity of alcohol-involved sexual violence questionnaire items. We used a cognitive-interviewing qualitative approach to analyze interviews with forty participants to better understand the cognitive and interpretive language nuances between "took advantage of while drunk" and being "too drunk to consent." Qualitative thematic analysis was conducted to identify and summarize differences in how stimuli were perceived and interpreted. Our thematic analysis identified three themes: (a) respondents used behavioral indicators as an indicator of impaired decision-making, (b) respondents perceived and expressed complexity in understanding alcohol-related consent, and (c) some respondents attributed the differences between the phrases to reflect experiences of either perpetration and victimization. The results underscore the importance of refining questionnaires using behavioral indicators of alcohol intoxication to differentiate between incapacitated and impaired alcohol-involved incidents, clarifying non-consent language, and being purposeful in describing a state or an action related to the consumption of alcohol, to better measure alcohol-involved sexual violence.