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/psychologic (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 managing behavioral issues
		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.

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