Malaysian Men Research Articles

Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey

BackgroundHigh prevalence of substance use among men who have sex with men (MSM) may drive the HIV epidemic in Malaysia but patterns of substance use among Malaysian MSM have not been examined. Our study investigated specific Malaysian MSM risk groups to determine the association between their substance use and sexual risk behaviors. MethodsData from Malaysian respondents (n=1235) in a large, multinational online survey of Asian MSM in 2010 were used to identify latent classes of substance use. Subsequent covariates were included in a joint model to predict class membership. ResultsThe 3-class model was identified as the best fitting model, which included: (1) ‘negligible substance use’ for those reporting none or using any substance sparingly; (2) ‘soft substance use’ for those using poppers, ecstasy and drinking before sex; and (3) ‘amphetamine-type stimulant (ATS) use’ for those using stimulants (methamphetamine, ecstasy), erectile dysfunction drugs and recreational drug use before sex. Men in the ‘ATS use’ category were significantly less likely to not know their HIV status (AOR: 0.30, 95%CI: 0.14,0.66), more likely to have had more than 6 male sex partners (AOR: 4.83, 95% CI: 1.92–12.2), to have group sex (AOR:4.07, 95% CI: 2.31–7.15), to report inconsistent condom use (AOR:2.01, 95% CI: 1.12–3.60), to be HIV-infected (AOR:3.92, 95% CI: 1.63–8.42) and to have had any sexually transmitted infections (AOR:3.92, 95% CI:1.70, 9.08), compared to men in the ‘negligible substance use’ category. ConclusionsOur study identified subgroups of Malaysian MSM with distinct substance use patterns and HIV-related risk profiles, which provides implication for targeting HIV prevention in this subpopulation.

The association between bone health indicated by calcaneal quantitative ultrasound and metabolic syndrome in Malaysian men

BackgroundPrevious studies on the relationship between bone health and metabolic syndrome (MS) have revealed heterogeneous results. There are limited studies employing bone quantitative ultrasonometry in evaluating this relationship. This study aimed to determine the relationship between MS and bone health in a group of Malaysian middle-aged and elderly men using bone quantitative ultrasonometry.MethodsThis cross-sectional study recruited 309 free living Chinese and Malay men aged 40 years and above residing in Klang Valley, Malaysia. Their demographic and anthropometric data were collected. Their calcaneal speed of sound (SOS) was measured using a CM-200 bone ultrasonometer. Their blood was collected for the evaluation of lipid profile, total testosterone and sex hormone-binding globulin. The joint interim MS definition was used for the classification of subjects. Multiple linear regression analysis was used to assess the association between SOS and indicators of MS and the presence of MS, with suitable adjustment for confounders.ResultsThere was no significant difference in SOS value between MS and non-MS subjects (p > 0.05). The SOS values among subjects with different MS scores did not differ significantly (p > 0.05). There were no significant associations between SOS values and indicators of MS or the presence of MS (p > 0.05).ConclusionsThe relationship between bone health and MS is not significant in Malaysian middle-aged and elderly men. A longitudinal study should be conducted to evaluate the association between bone loss and MS to confirm this finding.

OP-053 Serum Gamma-glutamyltransferase (GGT) and Cardiovascular Risk among Multiracial Healthy Men in Malaysia

OP-053 Serum Gamma-glutamyltransferase (GGT) and Cardiovascular Risk among Multiracial Healthy Men in Malaysia

Ethnicity, citizenship and reproduction: Taiwanese wives making citizenship claims in Malaysia

This paper focuses on the experience of one specific group of Taiwanese women married to Chinese Malaysian men to examine the contestational process of bidding for citizenship status in an ethnicized polity. Positioned within a trajectory of transnational linkages between origin and host countries, they achieve success through making use of networking links with co-ethnic Chinese Malaysian women who are well-positioned within government bureaucracy, while forwarding an argument based on familial ideology and the (reproductive) citizenship rights of their Malaysian husbands. As noncitizens, they nevertheless engage in socially contributive ‘acts of citizenship’ that signify their suitability as citizens, nonthreatening to social cohesion. Furthermore, they enhance their strategy by ethnic boundary-making efforts aimed at distancing themselves from People's Republic of China wives who constitute a stereotyped and stigmatized ‘other.’ The discussion makes a contribution to the literature on ethnicity, citizenship, and gender.

AB55. Asian men’s health report—China’s perspective

The Asian men’s health report which was published in 2013 is supported by the Malaysian Men’s Health Initiative and is endorsed by the International Society of Men’s Health. It was a review of the state of men’s health in Asia based on data collected from the WHO databases, country/region Governmental databases, United Nation Social and Economic Commission for Asia Pacific Region (UNESCAP) and individual studies on issues that are not found in the key databases, such as sexual health. We have updated the data and will be presenting the key findings from China’s perspective. The data which will be discussed includes life expectancy, lifestyle risk factors, communicable diseases, non-communicable diseases, cancers, andrology related problems, mental health and injuries.

‘A (Sensitive New Age Guy) with difference’

This paper explores the representations of gender identities in the discourse of 200 online personal advertisements by Malaysian men and women. Using a combination of discourse analytical tools and corpus linguistic techniques this study demonstrates the construal of identity as a complex interaction of identity categorization and attitudinal resources. I-statements and nominal groups (Halliday, 1994; Halliday and Mattheissen, 2004) form my points of entry and linguistic patterns are semantically classified according to attitude (Martin and White, 2005) and Social Actor categorization (Van Leeuwen, 1996, 2008). General patterns construing typical and atypical representations of gender identities were observed by comparing the types of structure, semantics and collocates the data revealed. Results showed that advertisers appear to orient to what is expected in the context of courtship initiation in this particular genre, and are found to produce socially specific verbal practices that correspond to what is sought by men and women in general – e.g. ‘the slim and attractive woman’ and ‘the successful man’. Additionally, findings are also found to challenge hegemonic gender practices, construing counter-stereotypes such as ‘the sensitive man’. More significant however, is the construal of a Malaysian identity type – i.e. ‘the simple person’ – that cuts across gender lines.

Awareness and utilization of HIV services of an AIDS community-based organization in Kuala Lumpur, Malaysia

In Malaysia, homosexuality is illegal; little is known about access to HIV prevention services among Malaysian men who have sex with men (MSM). We analysed PT Foundation outreach data to describe the profiles among MSM who accessed PT Foundation services and to examine factors associated with being aware of PT Foundation and having visited the organization. A survey was administered during weekly outreach throughout Kuala Lumpur from March-December 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of participants who were and were not aware of the PT Foundation. Binary logistic regression was used to identify correlates of MSM visiting the PT Foundation among those who had heard of the organization. Of 614 MSM, this study found significantly higher awareness of the PT Foundation among MSM who perceived they had "good" HIV knowledge (p = .026) and participants who reported always using condoms (p = .009). MSM who reported being paid for sex were 2.81 times as likely to visit the PT Foundation compared to men who did not. A subgroup of MSM known to be at high risk for HIV infection is accessing prevention services. Future studies should uncover motivations and barriers of accessing these services among MSM in Malaysia.

Association of genetic and non-genetic risk factors with the development of prostate cancer in Malaysian men

There is growing global interest to stratify men into different levels of risk to developing prostate cancer, thus it is important to identify common genetic variants that confer the risk. Although many studies have identified more than a dozen common genetic variants which are highly associated with prostate cancer, none have been done in Malaysian population. To determine the association of such variants in Malaysian men with prostate cancer, we evaluated a panel of 768 SNPs found previously associated with various cancers which also included the prostate specific SNPs in a population based case control study (51 case subjects with prostate cancer and 51 control subjects) in Malaysian men of Malay, Chinese and Indian ethnicity. We identified 21 SNPs significantly associated with prostate cancer. Among these, 12 SNPs were strongly associated with increased risk of prostate cancer while remaining nine SNPs were associated with reduced risk. However, data analysis based on ethnic stratification led to only five SNPs in Malays and 3 SNPs in Chinese which remained significant. This could be due to small sample size in each ethnic group. Significant non-genetic risk factors were also identified for their association with prostate cancer. Our study is the first to investigate the involvement of multiple variants towards susceptibility for PC in Malaysian men using genotyping approach. Identified SNPs and non-genetic risk factors have a significant association with prostate cancer.

Malay

Bone turnover markers (BTMs) are useful in the assessment of bone health status. However, the infl uence of age, ethnicity and body anthropometry on the level of BTMs in men remains understudied. This study aimed to determine the influence of these factors on the level of BTM, namely osteoclacin (OC) and C-terminal telopeptides of type 1 collagen (CTX-1) among Malay and Chinese men (N = 407) aged 20 years and above in Klang Valley. The subjects were recruited using purposive sampling method. Their height, body weight and body mass index were measured. Their blood was collected in the morning for serum OC and CTX-1 analysis using enzyme-linked immunoasorbent assays. Results showed that OC and CTX-1 levels were significantly higher in Malay compared to Chinese men (p 0.005). There were significant and negative correlations between OC and body mass index and weight, which were significant for men aged 20-39 years only (p 0.05). As a conclusion, levels of BTMs in Malaysian men could be infl uenced by age, ethnicity and body anthropometry. Thus, these factors should be taken into consideration in the evaluation of bone health status of men using BTMs. DOI : http://dx.doi.org/10.17576/jskm-1201-2014-02

Serum Osteocalcin Is Significantly Related to Indices of Obesity and Lipid Profile in Malaysian Men

Background and aim: Recent studies revealed a possible reciprocal relationship between the skeletal system and obesity and lipid metabolism, mediated by osteocalcin, an osteoblast-specific protein. This study aimed to validate the relationship between serum osteocalcin and indices of obesity and lipid parameters in a group of Malaysian men.Methods: A total of 373 men from the Malaysian Aging Male Study were included in the analysis. Data on subjects' demography, body mass index (BMI), body fat (BF) mass, waist circumference (WC), serum osteocalcin and fasting lipid levels were collected. Bioelectrical impendence (BIA) method was used to estimate BF. Multiple linear and binary logistic regression analyses were performed to analyze the association between serum osteocalcin and the aforementioned variables, with adjustment for age, ethnicity and BMI.Results: Multiple regression results indicated that weight, BMI, BF mass, BF %, WC were significantly and negatively associated with serum osteocalcin (p < 0.001). There was a significant positive association between serum osteocalcin and high density lipoprotein (HDL) cholesterol (p = 0.032). Binary logistic results indicated that subjects with low serum osteocalcin level were more likely to be associated with high BMI (obese and overweight), high BF%, high WC and low HDL cholesterol (p < 0.05). Subjects with high osteocalcin level also demonstrated high total cholesterol level (p < 0.05) but this association was probably driven by high HDL level. These variables were not associated with serum C-terminal of telopeptide crosslinks in the subjects (p > 0.05).Conclusion: Serum osteocalcin is associated with indices of obesity and HDL level in men. These relationships should be validated by a longitudinal study, with comprehensive hormone profile testing.

The Relationships between Thyroid Hormones and Thyroid-stimulating Hormone with Lipid Profile in Euthyroid Men

Background and Aim: Alteration in lipid profile is a common observation in patients with thyroid dysfunction, but the current knowledge on the relationship between lipids and thyroid hormone levels in euthyroid state is insufficient. The current study aimed to determine the association between thyroid hormones and thyroid-stimulating hormone (TSH) with lipid profile in a euthyroid male population.Methods: A total of 708 Chinese and Malay men aged 20 years and above were recruited in this cross-sectional study. Their blood was collected for the determination of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), free thyroxine (FT4), free triiodothyronine (FT3) and TSH levels. The association was analyzed using multiple regression and logistic regression models with adjustment for age, ethnicity, body mass index and FT4/FT3/TSH levels.Results: In multiple regression models, TSH was positively and significantly associated with TG (p<0.05). Free T4 was positively and significantly associated with TC, LDL-C and HDL-C (p<0.05). Free T3 was negatively and significantly associated with HDL-C (p<0.05). In binary logistic models, an increase in TSH was significantly associated with higher prevalence of elevated TG in the subjects (p<0.05), while an increase in FT4 was significantly associated with higher prevalence of elevated TC but a lower prevalence of subnormal HDL in the subjects (p<0.05). Free T3 was not associated with any lipid variables in the logistic regression (p>0.05).Conclusions: In euthyroid Malaysian men, there are positive and significant relationships between TSH level and TG level, and between FT4 level and cholesterol levels.

Determinants of doctors' decisions to inquire about sexual dysfunction in Malaysian primary care settings.

BackgroundPerceptions of how receptive men are to sexual health inquiry may affect Malaysian primary care doctors’ decisions to initiate such a discussion with their male patients. This paper quantifies the impact of doctors’ perceptions of men’s receptivity on male sexual health inquiry. Sexual health inquiry is one of the five areas in a study on determinants of offering preventive health checks to Malaysian men.MethodsThis was a cross sectional survey among primary care doctors in Malaysia. The questionnaire was based on an empirical model defining the determinants of primary care doctors’ intention to offer health checks. The questionnaire measured: (I) perceived receptivity of male patients to sexual health inquiry; (II) doctors’ attitudes towards the importance of sexual health inquiries; (III) perceived competence and, (IV) perceived external barriers. The outcome variable was doctors’ intention in asking about sexual dysfunction in three different contexts (minor complaints visits, follow-up visits and health checks visits). All items were measured on the Likert scale of 1 to 5 (strongly disagree/unlikely to strongly agree/likely) and internally validated.Results198 doctors participated (response rate 70.4%). Female primary care doctors constituted 54.5%. 78% of respondents were unlikely to ask about sexual dysfunction in visits for minor complaints to their male patients, 43.6% in follow up visits and 28.2% in health checks visits. In ordinal regression analysis, positive perception of men’s receptivity to sexual health inquiry significantly predicted the doctors’ intention in asking sexual dysfunction in all three contexts; i.e., minor complaints visits (P=0.013), follow-up visits (P<0.0001) and health checks visits (P=0.002). Perceived competence in sexual health inquiry predicted their intention in the follow-up visits (P=0.006) and health checks visits (P<0.001). Lower cost to health checks only predicted their intention in the follow-up visits (P=0.010).ConclusionsWhilst sexual health inquiry should be initiated in an appropriate context, ‘perceived receptivity’ to sexual health inquiry significantly affected doctors’ intention in initiating sexual health inquiry to their male patients. Malaysian men’s health may be substantially improved by strategies that assist doctors to identify patient ‘receptivity’.

Perception of masculinity amongst young Malaysian men: a qualitative study of university students.

BackgroundPerception of Masculinity plays an important role in men’s lifestyles and health behaviors. Although, the importance of masculinity has been widely discussed in men’s health literature, very little is known about the meanings of masculinity in the Malaysian setting. This research aimed to explore the meanings of masculinity among Malaysian university men.MethodsThis qualitative study utilized in-depth interviews with 34 young Malaysian university men, aged 20–30 years from three main ethnic groups in Malaysia (Malay, Chinese and Indian). Thematic analysis approach was used to extract data. NVIVO v8 qualitative software was used for data management.ResultsFrom the data collected several concepts emerged that reflected the meanings of masculinity from the participants’ view points. These meanings were associated with a combination of traditional and non-traditional norms that generally benefit men who behave according to culturally dominant role expectations. These included: “Having a good body shape”, “being respected”, “having success with women”, “being a family man”, and “having financial independence”. Socio-cultural factors, such as family environment, religion, public media and popular life style patterns helped to shape and reinforce the meanings of masculinities among university men.ConclusionsThis study revealed that the university context provided a particular culture for construction and reinforcement of the meanings of masculinities, which should be considered by the educators to help in development of healthy masculinities.

Total Testosterone and Sex Hormone-binding Globulin are Significantly Associated with Metabolic Syndrome in Middle-aged and Elderly Men

Testosterone and sex hormone-binding globulin (SHBG) have been shown to be associated with metabolic syndrome (MS) in men. This study aimed at validating these relationships in a group of middle-aged and elderly men and assessing their strength of association to MS. A cross-sectional study of 332 Malaysian men aged 40 years and above was conducted. The blood of subject was collected under fasting condition for determination of testosterone, SHBG, glucose and lipid levels. Their medical history, smoking and alcohol consumption status, waist circumference (WC), body mass index (BMI) and blood pressure (BP) were recorded. All testosterone and SHBG levels were significantly reduced in MS subjects compared to non-MS subjects (p<0.05). Testosterone and SHBG were correlated significantly with most of the MS indicators without adjustments. In multiple regression analysis, the triglyceride level was the only MS indicator that was significantly, inversely and independently associated with all testosterone measurements and SHBG (p<0.05). Waist circumference was significantly and negatively associated with SHBG level (p<0.05) though not independent of BMI. Total testosterone and SHBG were significantly and inversely associated with the presence of MS. Testosterone and SHBG are potential intervention targets for the prevention of MS in men.

Efficacy and safety of long‐acting intramuscular testosterone undecanoate in aging men: a randomised controlled study

To evaluate the efficacy and safety of long-acting i.m. testosterone undecanoate (TU) in Malaysian men with testosterone deficiency (TD). A total of 120 men, aged 40-70 years, with TD (serum total testosterone [TT] ≤ 12 nmol/L) were randomised to receive either i.m. TU (1000 mg) or placebo. In all, 58 and 56 men in the placebo and treatment arm, respectively, completed the study. Participants were seen six times in the 48-week period and the following data were collected: physical examination results, haemoglobin, haematocrit, TT, lipid profile, fasting blood glucose, sex hormone-binding globulin, liver function test, prostate- specific antigen (PSA) and adverse events. The mean (sd) age of the participants was 53.4 (7.6) years. A significant increase in serum TT (P < 0.001), PSA (P = 0.010), haematocrit (P < 0.001), haemoglobin (P < 0.001) and total bilirubin (P = 0.001) were seen in the treatment arm over the 48-week period. Two men in the placebo arm and one man in the treatment arm developed myocardial infarction. Common adverse events observed in the treatment arm included itching/swelling/pain at the site of injection, flushing and acne. Overall, TU injections were well tolerated. TU significantly increases serum testosterone in men with TD. PSA, haemoglobin and haematocrit were significantly elevated but were within clinically safe limits. There was no significant adverse reaction that led to the cessation of treatment.

Perceived physical activity barriers related to body weight status and sociodemographic factors among Malaysian men in Klang Valley

BackgroundPhysical inactivity has been acknowledged as a public health issue and has received increasing attention in recent years. This cross-sectional study was conducted to determine the barriers to physical activity among Malaysian men. These barriers were analyzed with regards to sociodemographic factors, physical activity level, BMI and waist circumference.MethodsSubjects in this study included 308 Malay men and 422 Chinese men aged 20 years and older. Subjects completed the International Physical Activity Questionnaire (IPAQ) and a questionnaire on barriers to physical activity, categorized into personal and psychological, physical and social environment barriers. Weight, height and waist circumference were also measured and BMI was calculated.ResultsDescriptive analyses showed that 79.3% of subjects were married, 52.1% had secondary educational level, 68.8% were still working, and 39.7% had household income between RM1500 to RM3500. The perception that other recreational activities with family and friends were more fun was the most frequently reported barrier, followed by weather, lack of discipline, lack of free time, lack of money, and lack of friends. Marriage status, educational level, household income, BMI, and physical activity status were shown to be associated with perceived barriers.ConclusionsTo increase participation in physical activity, policy makers should consider significant personal, social and environmental barriers when developing appropriate intervention programmes. Health-promoting strategies that increase awareness, knowledge, skills and motivation related to physical activity are required.

Epidemiology of smoking among Malaysian adult males: prevalence and associated factors.

BackgroundThree National Health and Morbidity Surveys (NHMSs) had been conducted in Malaysia in 10-year intervals from 1986–2006. Based on the latest NHMS survey in 2006, we describe the prevalence of smoking and identify the social and demographic factors associated with smoking among adult males in Malaysia.MethodsA cross-sectional study among 15,639 Malaysian adult males aged 18 years and above was conducted using proportional to size stratified sampling method. The socio-demographic variables examined were level of education, occupation, marital status, residential area, age group and monthly household income.ResultsThe prevalence of smoking among adult males in Malaysia was 46.5% (95% CI: 45.5–47.4%), which was 3% lower than a decade ago. Mean age of smoking initiation was 18.3 years, and mean number of cigarettes smoked daily was 11.3. Prevalence of smoking was highest among the Malays (55.9%) and those aged 21–30 years (59.3%). Smoking was significantly associated with level of education (no education OR 2.09 95% CI (1.67–2.60), primary school OR 1.95, 95% CI (1.65–2.30), secondary school OR 1.88, 95% CI (1.63–2.11), with tertiary education as the reference group). Marital status (divorce OR 1.67, 95% CI (1.22–2.28), with married as the reference group), ethnicity (Malay, OR 2.29, 95% CI ( 1.98–2.66; Chinese OR 1.23 95% CI (1.05–1.91), Other Bumis OR 1.75, 95% CI (1.46–2.10, others OR 1.48 95% CI (1.15–1.91), with Indian as the reference group), age group (18–20 years OR 2.36, 95% CI (1.90–2.94); 20–29 years OR 3.31 , 95% CI 2.82–3.89; 31–40 years OR 2.85 , 95% CI ( 2.47–3.28); 41–50 years OR 1.93, 95% CI (1.69–2.20) ; 51–60 years OR 1.32, 95% CI (1.15–1.51), with 60 year-old and above as the reference group) and residential area (rural OR 1.12 , 95% CI ( 1.03–1.22)) urban as reference.ConclusionThe prevalence of smoking among Malaysian males remained high in spite of several population interventions over the past decade. Tobacco will likely remain a primary cause of premature mortality and morbidity in Malaysia. Continuous and more comprehensive anti-smoking policy measures are needed in order to further prevent the increasing prevalence of smoking among Malaysian men, particularly those who are younger, of Malay ethnicity, less educated, reside in rural residential area and with lower socio-economic status.

Sex hormones in Malay and Chinese men in Malaysia: are there age and race differences?

OBJECTIVES:Variations in the prevalence of sex-hormone-related diseases have been observed between Asian ethnic groups living in the same country; however, available data concerning their sex hormone levels are limited. The present study aimed to determine the influence of ethnicity and age on the sex hormone levels of Malay and Chinese men in Malaysia.METHODS:A total of 547 males of Malay and Chinese ethnicity residing in the Klang Valley Malaysia underwent a detailed screening, and their blood was collected for sex hormones analyses.RESULTS:Testosterone levels were normally distributed in the men (total, free and non-sex hormone-binding globulin (SHBG) bound fractions), and significant ethnic differences were observed (p<0.05); however, the effect size was small. In general, testosterone levels in males began to decline significantly after age 50. Significant ethnic differences in total, free and non-SHBG bound fraction estradiol levels were observed in the 20-29 and 50-59 age groups (p<0.05). The estradiol levels of Malay men decreased as they aged, but they increased for Chinese men starting at age 40.CONCLUSIONS:Small but significant differences in testosterone levels existed between Malay and Chinese males. Significant age and race differences existed in estradiol levels. These differences might contribute to the ethnic group differences in diseases related to sex hormones, which other studies have found in Malaysia.

The Eurycoma Longifolia Freeze-Dried Water Extract-Physta Does not Change Normal Ratios of Testosterone to Epitestosterone in Healthy Males

Eurycoma longifolia is traditionally known for its adaptogenic properties and often used for the general well-being and increased performance in daily life. Methods: In a randomized, double blind, placebo-controlled clinical trial, 40 Malaysian men aged 30-55 years performed a battery of physical testings during which the ratio of Testosterone (T) to Epitestosterone (E) was analyzed. The daily intake was 300 mg of the freeze-dried water extract of Eurycoma longifolia root (Physta®, Biotropics Malaysia) or placebo for a period of 12 weeks. Results: At the end of the study the T/E-ratio in the herbal group ranged from 0.03 to 2.95 and was not significantly different from values at baseline (p=0.49). Further, the ratio-values for E. longifolia compared to placebo did not change over time. The weight lifting force which measures muscular strength using back & leg strength test, increased significantly from baseline to end of the study in the herbal group by approximately 14 kg (p=0.0166). Conclusion: The ratios of testosterone to epitestosterone did not change during a 12-weeks E. longifolia intake. The data suggest that this herb does not exhibit “doping”- like effects. Instead, muscular strength improved significantly in the back and leg with E. longifolia supplementation rendering this herb good for physical performance minus the doping effects.

Influence of Adiponectin and Resistin Gene Polymorphisms on Quantitative Traits Related to Metabolic Syndrome Among Malay, Chinese, and Indian Men in Malaysia

Influence of Adiponectin and Resistin Gene Polymorphisms on Quantitative Traits Related to Metabolic Syndrome Among Malay, Chinese, and Indian Men in Malaysia