I can imagine it being odd for some foreign visitors, but plenty of other languages use similar constructs, so it should be familiar to many visitors. The American usage of how are you? or how's it going? as a friendly greeting isn't much different from the Greek τι κάνεις;, the Spanish ¿cómo estás?, the German wie geht's?, etc. In all those cases the type of answer that's expected depends on social context, ranging from a quick "fine, you?" to varying degrees of an actual answer.