A new Harris Poll has revealed concern among adults about the link between playing violent video games and violent behaviour among teenagers.
A majority of adults (69%) agreed that playing video games could provide children with some skills like good hand/eye coordination.
However, 58% said there was a link between playing violent video games and teenagers showing violent behaviour.
Over half (56%) said there was no difference between playing a violent video game and watching a violent movie.
The poll looked at the views of more than 2,200 adults in the US.
It found that only a third (32%) said they understood everything or a lot about video game ratings.
Over a third (38%) said they knew nothing about the ratings system.
This was despite two-thirds of adults with video-gaming children in their households saying they used a video game's rating when deciding if their child was allowed to play it.
The figures compare poorly against familiarity with movie ratings, with 77% saying they understood everything or a lot, and TV ratings (50%).
Adults were also found to have less confidence in the ability of video game ratings to prevent children being exposed to inappropriate content, with only a third (32%) somewhat or very confident compared to movie (49%) or TV (39%) ratings.
Nearly half (47%) of Americans indicate being not at all confident in video game ratings' ability to do so.
A third of those surveyed indicated that they allow the young gamers in their households to play whatever they want.
When it comes to who's responsible, 73% strongly agreed that parents should be the chief regulators in deciding what video games their children are allowed to play.
Over half (56%) said the government should not interfere in who can and cannot buy video games. However 47% said there should be government regulations to limit access to violent video games.
Roughly half (52%) said industry self-regulation was the best way to regulate the video games children are allowed to play.
Mike de Vere, president of Harris Poll, said the findings indicated a lack of awareness about the video gaming rating system and "confusion in the market".