title: The "Something Else" of Sexual Orientation: Measuring Sexual Identities of Older Lesbian and Bisexual Women Using National Health Interview Survey Questions.
abstract: Terminology related to sexuality and gender is constantly evolving, and multiple factors are at play when individuals answer questions on surveys.
  
  
  
  We examined patterns of responding to the National Health Interview Survey (NHIS) sexual identity questions in a multisite health intervention study for lesbian and bisexual women aged 40 to 84 years.
  
  
  
  Of 376 participants, 80% (n = 301) chose "lesbian or gay," 13% (n = 49) selected "bisexual," 7% (n = 25) indicated "something else," and 1 participant chose "don't know the answer." In response to the follow-up question for women who said "something else" or "don't know," most (n = 17) indicated that they were "not straight, but identify with another label." One participant chose "transgender, transsexual, or gender variant," five chose "You do not use labels to identify yourself," and three chose "you mean something else." Lesbian, bisexual, and "something else" groups were compared across demographic and health-related measures. Women who reported their sexual identity as "something else" were younger, more likely to have a disability, more likely to be in a relationship with a male partner, and had lower mental health quality of life than women who reported their sexual identity as lesbian or bisexual.
  
  
  
  Respondents who answer "something else" pose challenges to analysis and interpretation of data, but should not be discarded from samples. Instead, they may represent a subset of the community that views sexuality and gender as fluid and dynamic concepts, not to be defined by a single label. Further study of the various subsets of "something else" is warranted, along with reconsideration of the NHIS question options.
authors.affiliation: Department of Health Education, San Francisco State University, San Francisco, California. Electronic address: meliason52245@yahoo.com.
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Eliason
authors.affiliation: Research and Education, Callen Lorde Community Health Center, New York, New York.
authors.forename: Asa
authors.initials: A
authors.lastname: Radix
authors.affiliation: Department of Family & Community Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Jane A
authors.initials: JA
authors.lastname: McElroy
authors.affiliation: Population & Family Health at Columbia University's Mailman School of Public Health, New York, New York; Public Health Solutions, Public Health Institute, New York, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Garbers
authors.affiliation: Office on Women's Health, U.S. Department of Health and Human Services, Washington, DC.
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Haynes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001727:Bisexuality / Q000523:psychology; D003625:Data Collection; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012649:Self Concept; D012725:Sexual Behavior / Q000523:psychology*; D000072339:Sexual and Gender Minorities; D019529:Sexuality; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D063106:Transgender Persons; D014481:United States; D008297:Male