i don't think that you are actually going to be able to create a database (.mdb file) by using Coldfusion alone.
i rememebr reading that someone had used cfobject to run microsoft classes that are installed with Access, to create the mdb file. Can't rememeber off the top of my head where i read this but will look around and see what i can find.
If you mean how do you create/delete a database table in access using coldfusion that is quite simple.
first you will need to create a datasource to a database on your server. lets call it dbSource
then make a coldfusion file that has got the following code in it
<!--- to create a table --->
<!--- put the field names and types (int, text etc) in the brackets below --->
<CFQUERY DATASOURCE="dbsource">
create table mynewtable (Field1 int ..... Field10 int)
</CFQUERY>
<!--- then to delete a database table --->
<CFQUERY DATASOURCE="dbsource">
drop table mynewtable
</CFQUERY>
put these two on seperate pages otherwise the table will be created and the dropped in the same process.
hope this helps