Cheek kissing is a ritual or social kissing gesture to indicate friendship, family relationship, perform a greeting, to confer congratulations, to comfort someone, to show respect. Cheek kissing is very common in the Middle East, the Mediterranean, Southern, Central and Eastern Europe, the Low Countries, the Horn of Africa, Central America and South America. In other countries, including the U.S. and Japan, cheek kissing is common as well at an international meeting between heads of state and First Ladies or members of royal and the Imperial families.