Culturally and Linguistically Appropriate Services

  • United States of American Culture
    The culture of the United States is a Western culture originally influenced by Native American cultures. Today, the United States of America is an ethnically and racially diverse country as a result of large-scale immigration from many different countries throughout its history.

  • Greetings

    • Man greeting Man – Men shake hands when greeting one another and maintain direct eye contact. A relatively firm handshake is the way to go. Light hugs are common between good friends and family. 

    • Woman greeting Woman – At a first meeting, a light handshake will suffice. Light hugs are common between good friends and family. 

    • Man greeting Woman – At a first meeting a regular handshake will do. Light hugs are common between good friends and family.  Note: When Americans say “Hi, how are you?,” they are only expecting a “Fine,” or a “Fine, thank you” or a “Good” in response. It is not usually an invitation to a lengthy conversation.

  • Communication and Contact
    Americans tend to speak in a direct informal manner. They are usually polite and friendly. Conversation topics to avoid include politics, religion, homosexuality, racism, abortion, and criticism of the government. It’s best to have a strong relationship in place before speaking about sensitive topics. Americans do not usually divulge how much money they make or how much they paid for certain things like a houses, car, etc. It tends to be considered rude to ask and is even more uncomfortable to discuss. 

    Americans value their personal space and tend to be comfortable with 2-3 feet of personal space during conversations. For most Americans there is little to no touching during conversations.  This may be different between good friends and family. Hugging is reserved for close family members and friends.  Americans value direct eye contact during conversations. It is viewed as a sign of respect and interest in what the person speaking is saying. Staring is considered rude and to be avoided, especially in the larger cities.

    The OK sign and “thumbs up” sign mean good or acceptable and are commonly used throughout the country. Whistling at performance events is a sign of appreciation. Waving can indicate both greeting and saying goodbye and is usually done by moving the entire hand from left to right with the palm facing outward.  Raising the middle finger is seen as highly offensive. Avoid using it, even when pointing to objects or scratching your face.

    In America, time is a very important commodity. People ‘save’ time and ‘spend’ time as if it were money in the bank. Americans ascribe personality characteristics and values based on how people use time. For example, people who are on-time are considered to be good people, reliable people who others can count on.

  • Taboos
    Race is a sensitive subject throughout the country. To avoid offending anyone refer to Americans of different ethnicities as such: African American, Italian American, Asian American, etc.  Spitting is usually unacceptable in public settings.  It is considered sexual harassment to ask questions of a personal nature. Asking a woman if they are a virgins, telling dirty jokes, sexual gestures and touching inappropriately is against hospital policy and can lead to termination of treatment.

  • Food
    The cuisine of the United States is extremely diverse, owing to the vastness of the continent, the relatively large population (1/3 of a billion people) and the number of native and immigrant influences.

    Mainstream American culinary arts are similar to those in other Western countries. Wheat is the primary cereal grain. Traditional American cuisine uses ingredients such as turkey, white-tailed deer venison, potatoes, sweet potatoes, corn, squash, and maple syrup, indigenous foods employed by American Indians and early European settlers. Slow-cooked pork and beef barbecue, crab cakes, potato chips, cotton candy and chocolate chip cookies are distinctively American styles.

    Americanized versions of cultural foods, such as American Chinese cuisine, Tex-Mex (Mexican-American cuisine) or Italian-American cuisine often eventually appear; an example is Vietnamese cuisine, Korean cuisine and Thai cuisine. German cuisine has a profound impact on American cuisine. Dishes such as the hamburger, pot roast, baked ham and hot dogs are examples of American dishes derived from German cuisine.  Different regions of the United States have their own cuisine and styles of cooking. The state of Louisiana, for example, is known for its Cajun and Creole cooking. Cajun and Creole cooking are influenced by French, Acadian, and Haitian cooking, although the dishes themselves are original and unique. Soul food, developed by African slaves, is popular around the South and among many African Americans elsewhere. Iconic American dishes such as apple pie, fried chicken, pizza, hamburgers, and hot dogs derive from the recipes of various immigrants and domestic innovations. Americans generally prefer coffee to tea, with more than half the adult population drinking at least one cup a day. Marketing by U.S. industries is largely responsible for making orange juice and milk (now often fat-reduced) ubiquitous breakfast beverages. During the 1980s and 1990s, Americans’ caloric intake rose 24%; frequent dining at fast food outlets is associated with what health officials call the American “obesity epidemic.” Highly sweetened soft drinks are popular; sugared beverages account for 9% of the average American’s daily caloric intake.

  • Technology in Culture
    Americans, by and large, are often fascinated by new technology and new gadgets. Many of the new technological innovations in the modern world were either first invented in the United States and/or first widely adopted by Americans. Examples include: the light bulb, the airplane, the transistor, nuclear power, the personal computer, the iPod, video games and online shopping, as well as the development of the Internet.

  • Gender Roles
    Since the 1970s, traditional gender roles of male and female have been increasingly challenged by both legal and social means. Today, there are far fewer roles that are legally restricted by one’s sex. The military remains a notable exception, where women may not be put into direct combat by law. More and more women have entered the workplace, and in the year 2000 made up 46.6% of the labor force, up from 18.3% in 1900. However, in the medical field it is typical for men and woman to have the rolls of doctors, physicians’ assistance and nurses, etc. Nursing is considered a highly respected position for both men and woman.

  •  Family Structure
    Today, family arrangements in the United States reflect the diverse and dynamic nature of contemporary American society. Although for a relatively brief period of time in the 20th century most families adhered to the nuclear family concept (two married adults with a biological child), single-parent families, childless/childfree couples, and fused families now constitute the majority of families.

    Individualism is prized, and this is reflected in the family unit. People are proud of their individual accomplishments, initiative and success, and may, or may not, share those sources of pride with their elders.

  • Sports and Community Culture
    Baseball is the oldest of the major American team sports. Professional baseball dates from 1869 and had no close rivals in popularity until the 1960s. Though baseball is no longer the most popular sport, it is still referred to as the “national sport”.

    Football, known in many anglophone countries as “American football”, is considered to be the most popular sport in the United States. The National Football League’s championship game, the Super Bowl, has often been the highest rated television show, with an audience of over 100 million viewers annually. Homecoming is an annual tradition of the United States. People, towns, high schools and colleges come together, usually in late September or early October, to welcome back former residents and alumni. It is built around a central event, such as a banquet, a parade, and most often, a game of American football, or, on occasion, basketball or ice hockey. When celebrated by schools, the activities vary. However, they usually consist of a football game, played on the school’s home football field, activities for students and alumni, a parade featuring the school’s marching band and sports teams, and the coronation of a Homecoming Queen.

    Other prominent sports included basketball and ice hockey. Boxing and horse racing were once the most watched individual sports, but they have been eclipsed by golf and auto racing, particularly NASCAR. Tennis and many outdoor sports are also popular. Soccer, known in the majority of the rest of the world as “football”, is played widely at the youth and amateur levels.

  • Art
    In the late eighteenth and early nineteenth centuries, American artists primarily painted landscapes and portraits in a realistic style. A parallel development taking shape in rural America was the American craft movement, which began as a reaction to the Industrial Revolution. Developments in modern art in Europe came to America from exhibitions in New York City such as the Armory Show in 1913. After World War II, New York emerged as a center of the art world. Painting in the United States today covers a vast range of styles.

  • Fashion
    Apart from professional business attire, fashion in the United States is eclectic and predominantly informal. Additionally, certain events may call for more formal attire, such as a dance, wedding, or formal party. While Americans’ diverse cultural roots are reflected in their clothing, particularly those of recent immigrants, cowboy hats and boots and leather motorcycle jackets are emblematic of specifically American styles. Blue jeans were popularized as work clothes in the 1850s by merchant Levi Strauss, a German immigrant in San Francisco, and adopted by many American teenagers a century later. They are worn in every state by people of all ages and social classes. Along with mass-marketed informal wear in general, blue jeans are arguably U.S. culture’s primary contribution to global fashion.

  • Theater
    Theater of the United States is based in the Western tradition and did not take on a unique dramatic identity until the emergence of Eugene O’Neill in the early twentieth century, now considered by many to be the father of American drama. Social commentary has also been a preoccupation of American theater, often addressing issues not discussed in the mainstream. Broadway is one of the largest theater communities in the world and is the epicenter of American commercial theater.

  • Music
    American music styles and influences (such as country, jazz, rock and roll, rock, hip hop, rap) and music based on it can/could be heard all over the world. Music in the US is very diverse, with many influences, including heavy African American influence in the 1900s. Hip-hop and pop are very common in radio, however rock and country are frequently played on the radio as well. Different generations will often go through different musical phases. The earlier 1900’s is famous for jazz, introduced by African Americans in the south. In the 1970s and 80’s, rock was very prevalent.