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©2013 UpToDate ® Print Email Biologic-behavioral-environmental risk assessment to guide decision-making when prescribing hormonal contraceptives for young teenagers Factors Definition Examples Biological Pubertal and metabolic factors Incomplete growth Decreased bone density/osteoporosis Lack of physical activity Behavioral/psychological (including neurocognitive) Mental health, neurologic, and emotional factors Poor self-esteem and self-efficacy Declining grades Learning disability Impulsive behavior Depression Substance abuse Environmental Parental/other caretaker supervision and monitoring Chaotic living situation Difficulty controlling teenager Lack of knowledge of teenager's whereabouts and friendships Depression and/or alcohol-substance use in parent Parental consent (active or passive) to date in late middle school or early high school Courtesy of Mariam R Chacko, MD.