Natural disasters.
The U.S. is a huge country with very varied geography, and parts of it are occasionally affected by natural disasters: hurricanes in June through November in the South including Florida, blizzards (sometimes called "Noreasters") in New England and the areas near the Great Lakes and the Rocky Mountains, tornadoes mostly in the Great Plainsregion, earthquakes in California and Alaska, floods in areas of the Midwestern United States and wildfires in the late summer and early fall in Texas and on the West Coast, particularly California. See the regions in question for more details.
Because tornadoes are so common between the Rocky Mountains and the Appalachian Mountains, this area has earned itself the colloquial name Tornado Alley. The San Andreas Fault is a tectonic plate boundary running through California, an area prone to earthquakes.
Disease.
Being a highly industrialized nation, the United States is largely free from most serious communicable diseases found in many developing nations; however, the HIV rate is higher than in Canada and Western Europe, with about a 0.5% infection rate in the overall population.
Two diseases that, while rare, are worth becoming educated about are rabies and Lyme disease. Rabies is more prevalent in eastern regions of the country and may be contracted from animal bites; if you are bitten by any mammal see a doctor quicklydo not wait for symptoms. Lyme disease is spread via the deer tick, which are prevalent in the woodlands and open fields of many rural areas. When venturing into the outdoors, it is a good idea to apply an insect repellent onto exposed skin surfaces that is effective against deer ticks.
Other diseases that are endemic within the United States, but are of far less concern, include Hantaviral Pulmonary Syndrome (found in western regions), Rocky Mountain Spotted Fever (mostly in the Rocky Mountain region), West Nile Virus (all regions)and Eastern/Western Equine Encephalitis (particularly in the mid-west region).
It should be noted that all of the above listed diseases are extraordinarily rare and the medical system of the United States is very much capable of handling any of these when necessary.
For the latest in traveler's health information pertaining to the United States, including advisories and recommendations, visit the Centers for Disease Control and Prevention destination United States website
Health care
The American health care system is world-class in quality, but can be very expensive. Americans generally use private health insurance, paid either by their employer or out of their own pocket; some risk paying high hospital bills themselves, or depend on government subsidized health plans. As a traveler you should have travel insurance or you will potentially face high costs if you need medical care.
Most metropolitan areas will have a mix of public and private hospitals, and in turn, U.S. private hospitals can be either nonprofit or for-profit. Public hospitals located in wealthy suburbs can be as good as private ones, but in poorer inner-city areas, public hospitals are usually overcrowded and run-down and should be avoided by tourists. However, many public hospitals are also the Level I regional trauma centers for their respective metro areas (i.e., they guarantee 24-hour on-site availability of all major types of medical specialists), which means that you will be taken there if critically injured.
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In a life-threatening emergency, call 911 to summon an ambulance to take you to the nearest hospital emergency room ("ER"), or in less urgent situations get to the hospital yourself and register at the ER's front desk. Emergency rooms will treat patients without regard to their ability to pay, but you will still be presented with a bill for all care. Do not use ERs for non-emergency walk-in care. Not only can this be 3-4 times more expensive than other options, but you will often wait many hours (or days) before being treated, as the staff will give priority to patients with urgent needs. In most areas, the charge for an emergency room visit starts around $500, in addition to any specific services or medications you may require. Most urban areas have minor emergency centers (also called "urgent care", etc.) for medical situations where a fully equipped emergency room would be excessive, such as superficial lacerations. However, their hours may be limited, and few are open overnight.
Walk-in clinics are another place for travelers to find routine medical care, letting patients see a doctor or nurse-practitioner without an appointment (but often with a bit of a wait). They are typically very up-front about fees, and always accept credit cards. To find one, check the yellow pages under "Clinics", or call a major hospital and ask. Make sure to tell the clerk you will be paying "out of pocket"; if they assume an insurance company will be paying for it, they may order tests that are not medically essential and in some cases bill for services that aren't actually provided.
Dentists are readily available throughout the United States (again, see the yellow pages). Dental offices are accustomed to explaining fees over the phone, and most will accept credit cards.
Most counties and cities have a government-supported clinic offering free or low-cost testing and treatment for sexually transmitted diseases; call the Health Department for the county you are in for more details. Many county clinics offer primary health care services as well, however these services are geared towards low-income residents and not foreign travelers. Planned Parenthood (1-800-230-7526) is a private agency with clinics and centers around the country providing birth control and other reproductive health services for both females and males.
Restrooms/toilets.
On average, most American public restrooms/bathrooms/lavatories are not as clean or pleasant as equivalent public toilets found in Western Europe or Japan. Some may be pristine, such as in upscale shopping malls, fine restaurants, or commercial office buildings. Others will be shockingly unkempt, such as at many gas stations and bars. Some toilet stalls offer disposable toilet seat covers if you are bothered by this, but those are far from being universal. (The main reason is that most American public facilities do not hire a janitor who is tasked specifically with maintaining the restrooms full-time; rather, American restrooms tend to be maintained by a facility's general janitorial staff only a few times a day, with predictable results.)
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Basically all public buildings are required to have handicapped accessible restrooms. Increasingly, restrooms offer baby changing stations in both the men's and women's restroom (these are mostly seen in shopping places and restaurants); a few places have a separate "family" restroom which is single-occupancy but spacious.
For little children who need to be monitored or assisted, it's generally acceptable for them to use the restroom of the parent they're with (little girls can go with dad to the men's room, and vice versa). The other way around (dad going to the ladies' room) is usually not okay.
Dress.
Today, dress in the U.S. tends to be fairly casual. For everyday clothes, jeans and T-shirts are always acceptable, as are shorts when the weather is suitable. Sneakers (athletic shoes) are common; flip-flops and sandals are also popular in warm weather.
At the workplace, business casual (slacks, understated collared shirts without a tie, and non-athletic shoes) is now the default at many companies; more traditional industries (e.g. finance, legal, and insurance) still require suits and ties, while others (e.g. computer software) are even more casual, allowing jeans and even shorts.
When dressing up for nice restaurants or upscale entertainment, a pair of nice slacks, a collared shirt, and dress shoes will work almost everywhere. Ties for men are rarely necessary, but jackets are occasionally required for very upscale restaurants in big cities (such restaurants almost always will have courtesy jackets on offer if you forget).
At the beach or pool, men prefer loose bathing trunks or boardshorts, and women wear bikinis or one-piece swimsuits. Nude bathing is not generally acceptable and is usually illegal except at certain private beaches or resorts; even women going topless is not usually accepted by most people, and is also illegal in some states.
Generally, Americans accept religious attire such as hijab, yarmulke, and burqa without comment. However, do be aware that in places of heightened security such as banks, municipal buildings, and so on, wearing clothing which covers the face may be regarded as suspicious behavior and is generally unadvisable.
Respect
Americans generally find foreign culture and language fascinating and you will likely be bombarded with questions that you may find silly or inane about your home. Questions such as these are nearly always meant in a friendly and inquisitive manner.
It is polite to shake hands when meeting someone or being introduced. It is often omitted in less formal situations.
Unless it is really crowded, leave about an arm's length of personal space between yourself and others.
As a result of the country's extensive history of racial discrimination, coupled with the country's more recent push toward racial equality, Americans are exceptionally sensitive about issues of race. If you must reference race, Black or African-American, Asian, Latino or Hispanic, Native American or American Indian, and White or Caucasian are acceptable terms.
Most Americans would say anyone from the Indian Subcontinent (a.k.a. South Asia) is Indian. They are often not aware that this can be a bit offensive to people from that region who are not from the country of India. (The next best single word is " subcontinental ", which is rather unwieldy and hardly ever used. Another term not likely to offend is "South Asian".)
Note also that when Americans use the term "Asian" by itself to refer to people, they are often specifically referring to East Asians (including Southeast Asians), and not to people from South Asia. In most parts of the US, East Asian communities are larger and more established than South Asian communities. (Note that this usage is exactly opposite that of British English, in which "Asian" by itself refers exclusively to South Asians, and East Asians are usually called "East Asians".)
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Most Americans are at least vaguely familiar with large countries in North America, East Asia, Western Europe, Australia/New Zealand, and the Middle East. But they are less likely to be familiar with small countries in other regions, especially those in South America, Central Asia, South Asia, Southeast Asia, Africa, and Eastern Europe. Thus, do not be surprised, and try to not be offended, if you encounter many Americans who have difficulty distinguishing Slovakia from Slovenia, Paraguay from Uruguay, or Uzbekistan from Kazakhstan.
Smoking indoors is heavily frowned upon and is illegal in most public buildings. If you're in a private home and feel the need to light up, politely excuse yourself and step outdoors.
It is not advised to speak directly to children you don't know. If you have something you'd like to say to a child, address the adult he or she is with.
Videotaping in any indoor public-use place is heavily frowned upon in the United States of America and can rather easily result in ejection from the premises, even without warning. Places that are especially against videotaping by visitors include shopping malls, stores, restaurants, museums, arcades, movie theaters, nightclubs, bars, taverns, and stadiums.
There are Native American reservations scattered throughout the country. Many of these reservations are home to sites that are sacred to the tribe, and certain places may be off-limits to all but tribe members. If you enter a reservation's territory, please be sure to respect the land.
